Re-posted from the Times Leader.

As she recovers from her second knee replacement, 69-year-old Mary Smithonic of Dupont describes the surgery as painful, but worth it.

“The pain from a bad knee is worse,” she said. “You wouldn’t want to live with it. Even sleeping at night is almost impossible. You try the shots and the painkillers but nothing really takes care of it.”

“I used to love to walk,” she said. “I definitely couldn’t do that. I couldn’t even stand to wash the dishes, so my husband (Andrew) has been washing dishes now for quite a while. He’s gotten quite good at it.”

After having her first knee replacement in November 2013, Smithonic had her second knee replaced late last year.

She has been going through physical therapy at the John Heinz Institute in Wilkes-Barre Township, and happily reports, “Each time you get up, there’s less pain.”

The surgeon who replaced both of Smithonic’s knees, Dr. George Ritz, will be the featured speaker at 4 p.m. Jan. 29 at the Keystone Grand Ballroom at Mohegan Sun at Pocono Downs in Plains Township.

It’s the first of two talks, sponsored by Commonwealth Health, during which an orthopedist will discuss how patients — especially those 55 or older with pain, swelling or stiffness in the knee or hip that is likely due to arthritis — might decide if or when it’s the right time for joint replacement.

Maureen Ledoretti of Plains Township has been thinking about that a lot and said lately she’s decided it’s a question of “when” as opposed to “if.”

“I know it’s got to be done,” she said, explaining her knee “really hurts, and steps are an issue. I’ve been trying to baby it along.”

For encouragement, Ledoretti can turn to her husband, Tom, who is pleased with the results of hip surgery from several years ago, and her 84-year-old aunt, who recently had a knee replacement.

“I can’t even go for a walk,” Ledoretti lamented, explaining she and her husband used to love ballroom dancing but now she can barely make her way into a grocery store or the mall on foot.

Hoping surgery will help her get around without pain, she said, “I’m leaning toward maybe by this summer.”

But it’s not something to take lightly, she said. “You don’t just get up one day and say, ‘I think I’ll have my knee replaced today.’ “

Commonwealth Health’s chairman of the orthopedic department, Dr. Michael Raklewicz agrees. You want to do your homework first.

“What I tell people, generally, is that if you have pain and disability because of a joint, specifically a knee, how much is it messing up your life? If you can’t enjoy a beautiful walk on a sunny afternoon, if you can only walk a block, then your health is being affected.”

“If your pain is leading you to a sedentary lifestyle, clearly that’s a problem. For your general health, you certainly should consider fixing this problem.”

The risks of surgery have been substantially reduced over the decades, Raklewicz said. “Thirty years ago it was a painful process and there were catastrophes such as poor placement and infections. But now we have better drugs, better ways to put the prosthesis in. Robots and computers make for a better alignment. With an experienced surgeon, you’re probably talking in the range of 1 percent or less that there could be nerve damage or infection.”

So, who might not be the best candidate for joint-replacement surgery?

“With very, very young people, in their 40s and earlier, you really have to look at this carefully because there is a time factor in the longevity of the prosthesis,” Raklewicz said.

If the prosthetic knee doesn’t last for the person’s lifetime, the patient will need another replacement.

Because of modern advances, the doctor said, the life span of a replacement knee has improved. “The FDA even allowed one company, Smith & Nephew, to say a product lasts 30 years,” he said.

Still, a very young person would likely outlive the 30-year prosthetic.

The person for whom surgery could be a much easier decision might be an older individual in so much pain he or she has been taking strong medication.

“If somebody’s in enough pain that they’re on narcotics, that’s a slam dunk,” he said. “That’s like living with a toothache and taking narcotics instead of going to the dentist.”

You can’t expect arthritis to go away on its own, Raklewicz said.

“Arthritis is one slow downhill curve. If doesn’t plateau out. There’s just more grinding away at cartilage and bones.”

And, waiting too long just makes surgery more difficult.

“Never a week goes by that a person doesn’t come in who had pain for five years or more and by this time there’s a deformity in the joint. It makes the operation more difficult. Waiting too long is a very bad thing.”