By Konrad Solberg 

The dread of aching joints as we get older is incredibly common.  

Many people assume that worn hips and knees –– and the surgeries needed to replace them –– are just inevitable parts of aging. 

But joint replacement is not always written in stone.  

“Living a healthy lifestyle, maintaining a healthy body weight, and low impact aerobic exercise coupled with resistance type strength training in general may help delay or possibly prevent replacement,” says Daniel R. Layon, M.D., a board-certified orthopaedic surgeon specializing in hip and knee replacements at VCU Health.

Layon discusses how the body carries weight, the truth about high-impact exercise and the lifestyle shifts that can help you delay or even avoid the operating table. 

Is joint replacement an inevitable part of getting older? If not, how can I avoid problems later in life? 

In the absence of injuries to the joints, structural disease of the joints or an auto-immune disease, joint replacement is certainly not inevitable.  

It is hard to give advice on how to avoid joint replacement because injuries can be unexpected and people’s medical problems can change over time.  

However, there are a few concrete steps people can take to improve their joint health, such as: 

• Living a healthy lifestyle 
• Maintaining a healthy body weight 
• Low impact aerobic exercise coupled with resistance-type strength training 

At what point is joint damage considered irreversible? 

Generally speaking, when we see severe arthritis of a joint –– which we define as complete loss of joint space, joint deformity, cysts forming in the bone and large bone spur formation –– we would consider that irreversible.  

That said, as surgeons, we try to treat our patients as people and not just treat them as X-rays. I have many patients with severe arthritis who want to avoid surgery, and we treat them with conservative and non-operative treatments for as long as possible.

Daniel Layon, M.D., a board-certified orthopaedic surgeon at VCU Health. (Enterprise Marketing and Communications)

We often hear that losing weight helps aching joints. How much pressure is removed from the knees and hips per pound of weight lost?

Because of the biomechanics of how weight is transferred to our hips and knees, excess body weight increases what we call the joint reactive force in the hip and knee. Joint reactive force is our way of conceptualizing the way our joints experience the effect of body weight.  

Studies have shown that our hips and knees experience approximately 2.5 to 3 times our body weight with each step. This explains how weight loss can improve joint health: every pound lost would offload 2 to 3 pounds on our joints.Studies have shown that our hips and knees experience approximately 2.5 to 3 times our body weight with each step. This explains how weight loss can improve joint health: every pound lost would offload  2 to 3 pounds on our joints. 

Does high-impact activity like running accelerate joint decay? 

At this time, the best knowledge that we have is that running does not cause arthritis. This has been specifically studied in the knee and although the data is mixed. One recent review suggested that running may improve knee pain in general and is not associated with an increased risk of developing arthritis.  

More anecdotally, exercise in general is critical for heart and lung health, bone density, muscle strength, fall prevention, mental health and many other things, so I think any risks of exercise would be far, far outweighed by the benefits. 

How much joint damage is caused by mechanical wear versus factors like inflammation? 

This is a complicated question. Generally speaking, we think of osteoarthritis as being caused by mechanical wear and inflammatory arthritis –– like rheumatoid arthritis –– as a distinct disease. There is often overlap between all of the causes of arthritis. Mechanical wear and inflammatory arthritis can also affect the same joint in patients with rheumatoid disease. 

What are the best non-invasive treatments to delay or prevent the need for a replacement? 

The best scientific evidence we have is that losing weight is the best way to improve your joint health.  

Other non-invasive treatments to manage arthritis include using interventions like wearing a brace to reduce swelling and instability, as well as anti-inflammatory medications and injections. It is hard to say with 100% certainty that these interventions can prevent the need for joint replacement, but it is important to remember that joint replacements are an elective surgery, meaning you can choose whether you want to get it. 

Do over-the-counter supplements like glucosamine and collagen actually help your joints? 

Supplements like glucosamine and collagen fall under the category of "may not help, but they probably won't hurt." Overall, I don’t recommend relying too much on supplements because, unfortunately, supplements are relatively un-regulated in the United States and can be contaminated with heavy metals or other substances.  

For our older patients, in particular, supplements may interact with prescription drugs as well. I recommend having a thorough discussion with your primary care provider about the risks and benefits of supplement use. 

What makes VCU Health’s orthopaedics team approach to joint replacement surgeries different? 

At VCU Health, we have a holistic, multi-disciplinary approach to joint replacement. We emphasize the importance of optimizing our patient’s health prior to surgical interventions to reduce the risk of perioperative and post-operative complications.  

We also utilize principles of enhanced recovery after surgery (ERAS) to speed patient recovery and enable same day discharges after joint replacement. Furthermore, access to care is one of our core departmental missions, so we prioritize having clinic and surgical time available so that we can reduce the amount of time our patients have to wait prior to being seen.

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