Good Health = Good Recovery After Knee Replacement Surgery
Your overall health is important and can have a major impact on how well you do after hip or knee replacement surgery. It is important to discuss your health with your surgeon so they can help you prepare in the time leading up to surgery. Your surgeon will want to know your health history, surgical history, medicines you are taking, allergies you may have, family history and social activities. You will also likely have a discussion about optimizing your health before surgery.
Health History
There are certain health issues that increase your risk of complications during and after joint replacement surgery. Your primary care provider and surgeon will determine which risk factors can be changed with improvements to your health (modifiable) and which factors cannot be changed, but must be addressed as best as possible (non-modifiable). Optimizing your health status prior to major surgery such as joint replacement reduces your risk of complications such as heart attack, stroke, blood clot, infection, readmission to the hospital, and need for repeat surgery.
Modifiable Risk Factors
These are problems that can be improved or fixed before having surgery. Examples are:
- Uncontrolled high blood pressure
- Getting blood sugar under good control if you have diabetes
- Goal Hgb A1C < 7.5, or Fructosamine < 287 (these thresholds may vary by institution)
- Stopping smoking, vaping, or using other nicotine products if you do
- Nicotine prevents the formation of new blood vessels and prevents healing after surgery. Nicotine can triple your risk of surgical complications.
- Losing weight if you are obese
- Overweight patients have much higher rates of complications during surgery from both the procedure and also from the anesthesia. After surgery obese patients have much higher rates of infection, problems with wound healing, and blood clots.
Your surgeon may recommend delaying surgery if you have modifiable risk factors that need to be improved.
Non-Modifiable Risk Factors
These are problems that cannot be fixed before surgery, but that your surgeon will address and determine if you can proceed with surgery. Examples are:
- Cancer
- Rheumatoid arthritis
- Lung disease
Some patients have severe health problems that can create a greater risk of problems with surgery. In these situations, you should have a discussion with your surgeon about other options for treatment.
Surgical History
Your surgeon will want to know what surgeries you have had in the past. This may affect your joint replacement surgery even if they weren’t orthopaedic surgeries. Certain surgeries, such as abdominal surgery or vascular surgery, can put you at risk for problems after joint replacement surgery. It is important to know if you had problems after any previous surgery such as infection, poor wound healing or a blood clot in the leg, arm or lung (deep vein thrombosis or pulmonary embolism).
Medication
It is important to provide details about all medications you take. This includes prescription and over-the-counter medicines and supplements. Many medicines can interfere with healing or place you at risk for problems such as increased bleeding. Examples of this are medicines used to treat rheumatoid arthritis that alter the immune system or blood thinners such as warfarin.
Allergies
It is important to inform your treatment team of any allergies you have. This includes allergies to medications, foods an metal. Knowing about medication allergies is very important because many different medications will be given around the time of your surgery. Allergic reactions to medications can be severe and even life threatening. Your surgeon needs to know if you have a history of metal allergy. This may mean visiting an allergist prior to surgery and/or taking special precautions with the replacement parts used in your surgery.
Family History
The health of your family (parents, siblings, and children) is helpful information for your surgeon. There are certain diseases seen in family members that can prompt your surgeon to take additional precautions with your care. This can include the history of a deep vein thrombosis/pulmonary embolism (blood clot to the arm, leg, and lung) or problems family members have had with anesthesia.
Social History
Social history describes your personal life and is helpful information for your surgeon to know. This includes if you work and what your job is, or if you are on disability or retired. Your surgeon will need to give you guidance about returning to work if you have a job. The timing of and restrictions for return to work of a construction worker is very different from a banker. Your safety and recovery are dependent on the environment you will return to after your joint replacement. Your surgeon will ask if you are independent or rely on others, if you have family or are alone and if you live in a nursing facility. Your surgeon also needs to know other aspects of your social life such as tobacco, alcohol and illicit drug use as this can have consequences on your care.
Optimization for Surgery
Your surgeon may discuss optimization before surgery. This means taking steps to make you safer to have surgery. This will frequently involve help from other providers. You may need to see your primary care provider before surgery if you have any health problems. You may also need to get information from your other providers, such as your lung or heart doctor. At times, the surgeon will need to have information from those providers to help manage your care. Your surgeon may have you see a specialist prior to surgery such as a nutritionist for weight loss or a vascular surgeon to evaluate the blood flow to your legs.
Managing modifiable and non-modifiable risk factors, learning about your medications and allergies, taking into account your family and social history and optimizing your safety prior to surgery are essential to a successful hip or knee surgery and recovery. These are individual decisions that must be made based on your specific situation with the help of your surgeon and primary care provider.
