By: Christopher J. Evanich, MD
When all nonsurgical options fail in treating your painful arthritic knee or hip, your surgeon may recommend a total joint replacement procedure. With over 1 million such procedures performed annually in the United States, this number is expected to double within the next 10 years due in part to the increasing age and life expectancy of the “baby boomers.” Total knee and total hip replacements are two of the most successful surgeries of any type in improving a patient’s function and quality of life. The success of the procedure, however, does not depend solely on your orthopedic surgeon and team’s expertise. It also depends on what you do prior to surgery that helps ensure a successful and satisfactory result for you to enjoy the coming years.
Here are some recommendations I share with my patients as a “To Do” list in preparation for their joint replacement surgery:
- Participate in low-impact aerobic exercises – Aerobic conditioning will certainly assist in your recovery in many areas especially in your post-operative physical therapy activities. Many exercises can increase pain in arthritic joints, but those activities such as swimming, water aerobics or using an exercise bike and elliptical can increase physical conditioning without putting too much stress on your painful joints.
- Quit using nicotine products – Nicotine causes restriction of blood flow and numerous studies have shown healing problems as well as decreased success rates in those using nicotine prior to surgery. This can be a very difficult “addiction” to overcome but your efforts will be well worth it, not only for your joint replacement outcome but also for your overall health.
- Lose weight if your BMI is over 40 – Body Mass Index (BMI) is a measure of body fat based on height and weight. The risks for postoperative complications increase by a factor of up to 10 for patients undergoing joint replacements who have a BMI over 40. These risks include infections, additional surgeries for loosening, wound healing issues and impant failure. There are many factors contributing to obesity including metabolic syndrome which usually require medical management to achieve successful weight loss.
- Maintain good blood sugars if you are a diabetic – The level of Hemoglobin A1c (HBA1c) in your bloodstream is an indicator of your average blood sugar level over the past two to three months. Normal HbA1c (nondiabetics) is between 4-5.5%. There is a potential for serious complications after your hip or knee replacement if your preoperative HbA1c is above 7-8%. Many surgeons will not perform an elective joint replacement surgery if your HbA1c exceeds this level.
- Address dental issues prior to surgery – Our mouths normally contain a multitude of bacteria which can easily access our bloodstream and potentially spread to your new hip or knee. Therefore it is highly recommended that any dental issues (e.g. cracked teeth, root canals or even periodic cleanings) be addressed prior to joint replacement surgery to minimize complications. After surgery, routine dental care can be performed three months later but premedication with antibiotics is required.
- Attend Joint Camp – Joint Camp is a one to two hour free informational session held approximately two weeks prior to your surgery. Here, you will be instructed in all phases of your surgery and recovery by both nurses and physical therapists. You will be provided with a binder full of educational information, exercises and checklists for your upcoming surgery. They will also provide a special antibacterial soap to use the night prior to and the morning of your surgery. Numerous national studies have shown that those attending this type of class have significantly better outcomes than those who don’t attend. Some hospitals have made this class mandatory prior to proceeding with surgery.
Remember, you play a large part in the success of your hip or knee replacement surgery. As I always tell my patients preparing for joint replacement surgery, “I can put it in, but you have to make it WORK!” Good luck.
To learn more about joint replacement options, turn to the experts at Midwest Orthopedic Specialty Hospital.