Improving Success of Hip & Knee Replacement Surgery

Hip and knee replacement surgery are some of the most common orthopedic surgeries offered. Every year, hundreds of thousands of patients undergo hip replacement or knee replacement for treatment of severe arthritis of their joints. Surgical treatment of arthritis with a joint replacement is one of the most successful surgical interventions, but there are complications that can occur, and when complications do occur they can be very serious. Complications may include ongoing pain, wound healing problems, stiffness, infection, and other problems.

When faced with chronic joint pain, complications may seem unlikely and easier to not think about.  People want to go into surgery focused on success rather than possible complications. That said, thinking about these potential problems associated with surgical procedures can actually be to your benefit. By understanding the possible complications of joint replacement surgery, and how you can control the likelihood of these risks, you can be an control of your outcome. Some simple steps may be the difference between a pain-free joint and a serious complication of surgery.

Preventing complications of joint replacement surgery is not always easy, but there are steps that can be taken. Some of the steps are taken by your doctor, but some of these steps must be taken by you! Below are some of the things that you can control that can help insure the best chance at a successful recovery from joint replacement surgery.

1
Weight Loss

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Obesity is becoming more common in most of the developed world, and the number of people seeking joint replacement is increasing dramatically as a result. As a population becomes more obese, the prevalence of joint pain becomes much more common. As people experience more pain, more people seek joint replacement surgery to relieve this discomfort.

The problem with obesity is that while it makes joint replacement more common, it also makes it more risky. People who have a body mass index (BMI) of more than 40 had a much higher risk related to joint replacement surgery. These risks include a higher chance of reoperation, a higher chance of infection, and a higher likelihood they will require revision joint replacement surgery.

People considering joint replacement surgery can focus on reducing weight prior to surgery. Weight loss can be difficult in the setting of chronic joint pain, but there are ways to exercise and lose weight that may not place too much stress on joints. People wanting the best results from joint replacement surgery should focus on efforts to reduce weight to a normal BMI.

 

2
Quit Smoking

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Smoking tobacco products is known to have significant effects on many aspects of health and healing. Specifically, tobacco effects microvascular circulation, which has direct impacts on healing after surgery, including joint replacement surgery.

The exact impact of smoking tobacco products on outcomes after joint replacement surgery are not entirely understood, but it is well known that people who smoke tobacco products have higher chances of developing wound infections, wound healing problems, and the need for readmission to the hospital after their joint replacement surgery.

Some surgeons are starting to test patients for nicotine in order to help ensure their patients have the best possible surgical outcomes. It is well known that quitting smoking prior to surgery can improve an individual's result from joint replacement. The exact amount of time to be off of nicotine products is not exactly known, but most surgeons agree if somebody can quit smoking for a minimum of six weeks, if not longer, prior to undergoing surgery they will likely significantly reduce their risk of complications to be closer to that of a nonsmoker.

3
Avoid Alcohol

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Alcohol consumption is known to be a risk for people undergoing surgical procedures. Specifically, people who drink alcohol regularly can develop post surgical complications if their alcohol consumption is not known to their healthcare team. While some studies have shown people who drink alcohol infrequently or in moderation are unlikely to have any higher risk related to joint replacement surgery, there are risks that can occur when people who drink alcohol more regularly or more substantially undergo a major surgical procedure.

Refraining from regular alcohol consumption prior to surgery is important, but equally important is informing your healthcare team about the amount of alcohol you regularly consume. It is much better to inform your doctor and nursing team prior to surgery about your amount of alcohol consumption. If possible, limiting alcohol consumption prior to elective surgery can help to prevent complications. The most common complication of people who consume higher amounts of alcohol is a prolonged hospitalization.

It is well known that people often underestimate the amount of alcohol they consume. If you are unsure of how much you drink, simply keep a daily log. This is for your benefit! Just write down how many drinks you consume each day for a week. Giving this information to your health care provider can help them manage and prevent complications when you undergo surgery.

 

4
Address Anemia

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Someone who is anemic has a low red blood cell count. This means that they lack the number of oxygen-carrying cells in their bloodstream, which can cause problems related to healing, and increases the chance that someone will need a blood transfusion after having a joint replacement.

There are several reasons why someone might be anemic. Some of the possible reasons include:

  • Iron deficiency
  • Kidney dysfunction
  • Inflammatory conditions

The treatment for different types of anemia will vary. Straightforward iron deficiency anemia is often managed with nutritional supplements, whereas other types of anemia may require medications or other interventions.

Most often, postoperative anemia can be prevented by addressing a low blood count prior to surgery. Unfortunately, this is often neglected, and by the time someone gets to surgery, they are starting with a low blood count. Talk to your primary care physician about your red blood cell count, and whether or not there are steps that you should take in order to address anemia.

5
Maintain Mental Health

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Often neglected, mental health plays a significant role in the likelihood of a successful outcome after joint replacement surgery. People who have clinical depression are more prone to developing complications, are less satisfied with the results of the surgery, and have a higher chance of needing revision joint replacement.

It is important to identify people who have clinical depression prior to undergoing joint replacement surgery. These individuals tend to struggle, especially in the early postoperative time. Not only does depression increase the level of pain experienced, but it can actually increase the likelihood of complications and the chance of needing additional surgical procedures. Lastly, people who have poor mental health scores based on standardized assessments, tend to have less satisfactory outcomes following surgery.

Trying to tease apart the interplay between joint pain and mental health is challenging, but with the use of standardized patient reported data, surgeons are getting better at predicting which people might struggle with recovery following joint replacement surgery. These individuals can be specifically treated by mental health professionals prior to undergoing surgery in order to address their mental health in an effort to optimize their results from joint replacement surgery.

A Word From Verywell

Making the decision to undergo joint replacement surgery is undoubtedly one of the most significant decisions you will face in your lifetime. The good news is that the results are almost always positive. However, there are complications that can occur, and avoiding these complications should be one of your top priorities. Following these steps will help you maintain control of your risk of complication.

Sources:

Alexander DP, Frew N. Preoperative optimisation of anaemia for primary total hip arthroplasty: a systematic reviewHip Int. 2017 Jun 7:0.

Browne JA, Sandberg BF, D'Apuzzo MR, Novicoff WM. Depression is associated with early postoperative outcomes following total joint arthroplasty: a nationwide database studyJ Arthroplasty. 2014 Mar;29(3):481-3.

OrthoCarolina Hip and Knee Center, Charlotte, North Carolina 28207, USA . Obesity and total joint arthroplasty: a literature based reviewJ Arthroplasty. 2013 May;28(5):714-21.

Rotevatn TA, Bøggild H, Olesen CR, Torp-Pedersen C, Mortensen RN, Jensen PF, Overgaard C. Alcohol consumption and the risk of postoperative mortality and morbidity after primary hip or knee arthroplasty - A register-based cohort study. PLoS One. 2017 Mar 17;12(3):e0173083.

Sahota S, Lovecchio F, Harold RE, Beal MD, Manning DW. The Effect of Smoking on Thirty-Day Postoperative Complications After Total Joint Arthroplasty: A Propensity Score-Matched Analysis. J Arthroplasty. 2017 Aug 1. pii: S0883-5403(17)30674-5.​

 

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