At times, Joe Heringhaus will pause in mid-step, marveling at how much his life has changed.

Gone is the near-constant pain that he knew his entire adult life, gone are the nighttime pangs from an arthritic knee that would wake him from sound sleep.

At times, it seems his is a wholly different life now that he's had knee replacement surgery.

Heringhaus, a chief with the Covington Fire Department, was injured playing football in high school and later served 25 years "” with an aching knee "” with the department before retiring in 2005. By the end of his service, he was fairly dragging his right leg because of the pain, he says.

For years, doctors told Heringhaus he needed knee replacement surgery. He put it off until his retirement, a move he now regrets.

"I can't believe how much better my life is," says Heringhaus. "I wish I had listened to my doctors and had it done when they first told me to. I'm walking around without any pain, and playing 18 holes of golf with my buddies, which I couldn't do before. Sometimes, I forget that (the implant) is even there."

Ramona Carr is still waiting for the day she can forget about her new right knee implant. Having just had the surgery in January, she still frets about the scar and remembers post-operative pain quite vividly.

Carr, the mayor of New Richmond, put off her surgery for at least three years, letting doctors try injections and other therapies before opting to go under the knife. As a former EMS chief and a current manager with the Angels Above and Beyond home health care service, she was well-versed on the pain and rehabilitation involved, and was reluctant.

She also knew, though, that she wanted to be able to play with her first granddaughter, Raegan, who was born in December.

"So, I finally gave in and had it done," says Carr. "Afterwards, the pain when I woke up that first time made me see stars, but even then I knew that arthritis pain was gone. It was amazing."

Six months af ter doctors at Wellington Orthopaedics performed the surgery, she's working out on an exercise bike daily and talking three-mile walks, pleasures she's been denied for years.

Carr and Heringhaus are just two of the 1 million patients the American College of Rheumatology estimates undergo total joint replacement surgeries each year, whether it is to replace damaged or arthritic knees, hips and shoulders, or even smaller joints "” wrists and ankles. Medical advancements, especially during the last decade, have made the procedures quicker, safer and less painful. Meanwhile, a growing number of baby-boomers who want to continue living active lifestyles are making joint replacement more commonplace.

"Not long ago, if a patient came to you with pain from a damaged joint, the solution was to limit their activity," notes Dr. Tim Kremchek, the Reds' team doctor and a surgeon with Beacon Orthopaedics and Sports Medicine in Sharonville.

"The mindset has changed. If you're an active 45 year old, and you have that kind of pain, why would you want to wait 15 years to have something done?"

As recent as a decade ago, younger patients were discouraged from total joint replacement because implants were thought to only last 10-15 years.

Together with pain, rehabilitation expectations and chances for problemswith new joints, many doctors were guiding patients to postpone surgery until later in life, lessening the chances of having to undergo a second replacement in their lifetime.

All that has changed, says Dr. Angelo Colosimo from University Orthopaedic and Sports Medicine.

Colosimo, Heringhaus' doctor and the director of Sports Medicine at the University of Cincinnati Medical Center, runs down the list: "The prosthesis itself has changed, the design of it and the actual makeup of it, the surgical procedure has changed, the physical therapy has changed. When I was training at Duke, a total joint replacement was a major event. Now, I can do a knee in 45 minutes, and patients can have a normal life again in weeks. The whole procedure has advanced tremendously."

"Age played a role, not so much in how old the patient was, but how many years they had left because at the time implants were expected to last eight to ten years," agrees Dr. Jerry Magone of Orthopaedic and Sports Medicine Consultants. "So, if you had the surgery earlier, you'd end up having to go through it again when the implant wore out. You had to remove the whole implant, a whole new surgery and the bone was now different. Now, you can just pop out the plastic pieces and pop in new ones. Technology has allowed us to push that envelope, and take patients earlier.

"I give a lot of credit to engineers," continues Magone. "The quality and design of implants is one area, but even when we f irst had supermetals and advanced plastics, we still didn't have decent equipment to place implants as precisely as we do today."

Like Colosimo, Magone tried computer- aided placement systems, but has gone back to previous methods. "Doctors who do the number of procedures we do with the jig system are comfortable with it and it works. The computer systems need three points of reference, like a GPS system, so you have to put three pins in the bone so the computer knows where the bone is. So, you have that additional part of the surgery. Until those pins are part of the implant itself, and that extra part of the procedure is gone, most doctors probably won't be using computers very much."

Patient Ron Corradini can certainly attest to advancements in the field.

The former Sycamore High and college football coach had to wait 15 years before having surgery to replace his arthritic left hip. Diagnosed at 35, doctors told him to hold off until he turned 50 to get his hip replaced. He waited as long as he could: two months after his 50th birthday in 1987.

Another 15 years later, in 2002, he had his right hip replaced.

"It was a big difference," says the retired teacher and coach.

After his first surgery at Joint Implant Surgeons in Columbus in 1987, he was walking with at least a cane for the better part of a year.

"After the second one, everything was back to normal within six weeks. The same doctors did the surgery, but the surgery itself was just so much more advanced," he says. Corradini, now 71, lives just off the Jack Nicklaus golf course in Mason. Without pain in either hip now, he sometimes wanders out his back door and plays a few holes of golf on the course. "I couldn't have done that before," he says.

Total joint replacement surgery is complex, but reads like simple carpentry.

O nce surgeons have access to the joint "” the hard part of the surgery, Colosimo says, is not damaging the muscles, nerves and other soft tissues to get to the bone "” the ends of the bones of the damaged joint are removed. Canals in the middle of remaining bones are hollowed out to accept rods from an implant, a new joint made from high-tech plastics, ceramics and metal.

Once the implant is in place, surgeons replace the soft tissues and close the incision.

New practices called "minimally invasive surgery," with smaller incisions, are still being refined, though doctors are divided about its benefits weighed against potential problems of a misaligned joint. Doctors are also beginning to use computers to aid in exact placement of implants.

After surgery, patients can expect pain. Doctors are sawing bone, after all, but in some cases, it's little worse than the pain they faced every day with their arthritic joints.

For some, there's little pain at all, like federal judge Arthur Spiegel. At the age of 81, he finally gave in and had hip replacement surgery in 2002 at Deaconess Hospital.

"My hip had been so painful I could barely move. It would lock up on me. I couldn't even sit for very long. It was an annoyance. No matter how much you shifted, it was uncomfortable," Judge Spiegel explains. "I don't recall any pain from the surgery. Maybe I have a high threshold for it, or maybe it was because it didn't compare to what I had been feeling."

Six years on, Spiegel is still on the bench, plays tennis regularly with friends and continues to f ly his own small aircraft, all without hip pain. He credits it to the skill of his doctors, and physical therapy.

Following hip or knee replacements, patients are often on their feet the same day, according to protocol. They can expect a hospital stay of three to five days, using a walker for a few weeks before progressing to using a cane while physical therapy continues.

By far, the longest recovery time comes with replacing a shoulder.

"It's a more difficult surgery, technically harder because of the structures and soft tissues around the joint, and it has to be done more precisely," Colosimo explains. "With hips or knees, patients can use walkers, but after a shoulder they can't use their upper extremities at all, so it's a bit harder on the patient."

After being released from the hospital within three days, patients are restricted to very limited activity with the arm for six weeks, using a pulley system to raisethe arm and keep the new joint from stiffening. They sleep with a sling on the arm to prevent injuring the new joint. After a few weeks, patients begin a rehab program to strengthen the muscles around their shoulder, which usually takes another three months.

Elbow, wrist and ankle replacements are less commonplace, doctors say, a last-option procedure that is still working toward the dependability of larger joint replacements. Smaller bones, the nature of the joint and the soft tissues and verves around them mean a trickier procedure, and greater potential for problems. With wrists and elbows rehabilitation time is quicker, but ankles, because they bear weight, can be slow. Patients are restricted from putting significant weight on their new ankle for up to six weeks.

While the art of joint replacement surgery has changed dramatically in recent years, so too have the implants. Now, finely manufactured and designed implants may last the rest of the patient's life.

Changes range from newer designs that add stability, ceramics that mimic bone, to newer metals and plastics, and unprecedented manufacturing standards, reveals Dr. Tom Lindenfeld from the Cincinnati Sportsmedicine and Orthopaedic Center.

"Most of the metals in implants are the same metals that have been used for 30 years, but the metallurgy is better, the milling is better, and there's less of a chance for problems in the future that we have to revisit surgically," Lindenfeld says.

In hips, doctors are finding that 90 percent of implants are lasting longer than 15 years "” as opposed to the 10-year-lifespan doctors expected in the past "” and 75 percent of implants are lasting at least 20 years, Lindenfeld says.

"And that's all from 20-year-old technology, because patients have to have had the implants long enough for us to gauge that information," Lindenfeld adds. "Today's implants are clearly better. It's entirely possible that we'll see them last 30 to 35 years, or even more."

With all the advancements, doctors are having little trouble finding proponents for joint replacements. They only have to look to patients. "When you have a joint that's boneon- bone, there aren't a lot of options," posits Colosimo, "but I never tel l someone we have to do it. They tell me. When they're tired of the pain, they tell me 'Let's get it done' and they're amazed afterwards when the pain is gone."

Corradini, his hip implant from 1987 still performing perfectly, has advised friends to not put joint replacement off, including his 35-year-old son, who had a damaged hip replaced last year.

Heringhaus, too, sings the praises of his new knee to anyone thinking of undergoing the procedure.

"I tell them, 100 percent, do it. It'll change your life," he says.