When Joints Fail: Understanding the Rise of Knee and Hip Replacements

The article “Walking on jagged gravel’: When knees, hips give up” that appeared in the SMH recently explored the rising prevalence and complexity of joint replacements, particularly among aging populations in Australia. Through real-life patient stories and expert insights, it delved into the causes of joint deterioration—primarily osteoarthritis—and the multifaceted decision-making process surrounding surgical intervention. The article highlighted the physical, mechanical, and genetic factors contributing to joint failure and emphasizes that while joint replacement can greatly enhance quality of life, it is not a simple fix and should come only after exhausting non-surgical options.

David Parker, a 75-year-old with a history of knee surgeries, experienced severe knee failure and ultimately underwent double knee replacement after a fall in Tokyo. Joint replacements in Australia number around 150,000 annually and are growing by about 5% per year, mostly in people in their late 60s. While surgery can offer a new lease on life, experts stress it’s not a quick fix and comes with risks like infections or implant failure.

Most joint failures stem from osteoarthritis (OA)—a whole-joint disease, not just cartilage wear. Age, body weight, joint shape, and previous injuries (especially ACL or meniscus tears) are leading causes. OA risk is higher with age—up to 30% in people over 75.

Surgery is generally considered only after non-operative treatments fail. Guidelines recommend trying weight management, physical therapy, low-impact exercise, and patient education first. Surprisingly, x-ray severity doesn’t always match a patient’s pain level, particularly in knees.

Many can manage OA symptoms without surgery using lifestyle changes, pain meds, platelet-rich plasma therapy, and specialized footwear. However, some, like Anna Mathieson, eventually require surgery after exhausting all options.

Modern joint replacements use materials like metal, ceramic, or plastic, and are customized to patient anatomy. The knee is particularly complex due to its hinge and gliding motions, making surgeries more intricate than hip replacements.

Recovery can take up to a year, with intensive physiotherapy and at-home exercises critical for regaining function. Results vary: hips tend to feel more “normal” post-op than knees. Many patients report life-improving outcomes despite some lingering strangeness in joint sensation.

Joint replacements are a powerful tool for restoring mobility and reducing pain in those with advanced osteoarthritis, but they’re major surgeries best reserved for when conservative measures no longer suffice. Prevention, weight management, and muscle strengthening play key roles in delaying or avoiding surgery.