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 pays off directly in post-operative physical therapy. The stronger your cardiovascular base going in, the better you recover coming out. Many exercises stress arthritic joints too much to be practical, but swimming, water aerobics, a stationary bike, and an elliptical build real conditioning without adding pain. If you haven’t been active, start now. It matters.
Stop using all nicotine products – Nicotine restricts blood flow. Study after study has tied nicotine use to healing problems and lower success rates in joint replacement patients. This applies to everything — cigarettes, cigars, chewing tobacco, nicotine pouches, vaping, e-cigarettes. The delivery method changes; the physiological effect doesn’t. Stopping is hard. It’s also worth it, for this surgery and for everything after it.
Lose weight if your BMI is over 35 – Body Mass Index measures body fat relative to height and weight. Above a BMI of 35, the risk of postoperative complications rises substantially — infection, wound healing problems, implant failure, the need for additional surgeries. Many orthopedic surgeons now treat 35 as a meaningful threshold, though your surgeon will evaluate your full picture, not just a number. Obesity often involves metabolic factors that require medical management to address successfully. Talk to your care team about where you stand before your procedure date arrives.
Control your blood sugar if you are diabetic – Hemoglobin A1c (HbA1c) reflects your average blood sugar over the past two to three months. In non-diabetic patients, normal HbA1c runs between 4 and 5.5%. Above 7.5%, the risk of serious complications after joint replacement — infection, impaired healing — increases in ways that are hard to manage after the fact. Many surgeons will postpone elective joint replacement surgery until blood sugar is better controlled. Your HbA1c will be part of your pre-operative workup. Know your number. Work with your primary care physician or endocrinologist if it needs to come down.
Address dental issues prior to surgery – The mouth carries a significant amount of bacteria, and those bacteria can reach the bloodstream and travel to a new joint. Any outstanding dental work — a cracked tooth, a root canal, a cleaning that’s overdue — should be handled before your surgery date, not after.
Consider antibiotic prophylaxis for dental care after surgery: current AAOS guidance treats this as an individualized decision, not a universal requirement. Your specific health history and risk factors determine the right approach. Your orthopedic surgeon and your dentist should communicate directly on this. If you have questions, ask your MOSH care team before you schedule any dental appointment post-surgery.
Complete Joint Effort Education – Before your surgery, MOSH asks every total hip and knee replacement patient to complete the Joint Effort Education program — a free, self-directed video series you can access online at your own pace, on your own schedule.
The program walks you through four essential areas of preparation:
- Preparing for Surgery — what to expect and how to get ready
- Preoperative Exercises — movements designed to strengthen you before your procedure
- At the Hospital — what your surgical experience will look like
- At Home — how to manage your early recovery safely and effectively
Hip replacement patients will also download and review precaution guides specific to their surgical approach — anterior or posterior — along with adaptive equipment guidance where applicable.
After completing all four videos, patients fill out a brief acknowledgement form confirming they’ve finished the program. If you have questions after watching, your MOSH nurse navigator is available at 414-817-5792.
National studies consistently show that patients who complete this type of pre-operative education have significantly better outcomes than those who don’t. The Joint Effort program puts everything you need to know in one place, in a format you can return to as many times as you need before your surgery date.
Access the Joint Effort Education program here.
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.