By Jim Davidson, MD and Katie Fultz, PA-C
Blanchard Valley Orthopedics & Sports Medicine
Often a patient has been diagnosed with severe osteoarthritis of a large joint (hip, knee, shoulder) and among treatment options discussed, joint replacement surgery may be considered. Typically, a joint replacement is reserved for the treatment of severe osteoarthritis when non-surgical treatments are no longer working. A joint replacement is replacing the cartilage ends of two bones where they come together to make a joint with a metal and plastic prosthetic. Once a patient has met with their orthopedic provider and decided a joint replacement is the right treatment option for them, there is preparation that can be done. This preparation is crucial to joint replacement success. Often, some of these things should start to be addressed upon initial diagnosis of the disease.
In most settings, a joint replacement is an elective procedure and should be implanted in the best possible setting. Some items take time to modify and others can be done more rapidly. The sooner they are addressed, the less likely they will delay implantation once a patient has decided to proceed with surgery. Often it takes collaboration with other providers such as primary care, endocrinology, nutrition, bariatrics, etc. to help a patient reach their pre-operative goals. The better condition a patient is in when headed into surgery, the greater likelihood of a satisfactory outcome.
One of the first aspects to evaluate when preparing for a total joint replacement is a patient’s health. A patient must quit all tobacco and nicotine products at least four weeks prior to their procedure. These products significantly affect the entire body and its healing process from increasing risk of adverse events, during and after the procedure, deep vein thrombosis (DVT), pulmonary embolism (PE), increasing incision healing complications and increasing the risk of latent peri-prosthetic joint infection. A patient’s weight can also significantly affect the likelihood of sustaining an adverse event after surgery. A body mass index (BMI) of over 35 starts to increase a patient’s risk and a BMI of over 40 increases a patient’s risk even more. Risks include wound healing complications, blood clot and early implant loosening. A patient should consider losing weight if their BMI is over 35 and must lose weight before proceeding with surgery if their BMI is over 40.
A joint replacement is obtained for the life of the patient. The goal of the orthopedic provider is not just to have their patients lose weight to reduce their risk during the perioperative period, but to develop habits that carry through for the entire lifetime of care of the joint replacement. If a patient gains weight back to a higher BMI, the higher likelihood of failure of the prosthetic, return of knee pain and dissatisfaction.
Chronic conditions such as of the heart, lung or kidneys should be stabilized and at their optimum treatment before proceeding with the joint replacement. Diabetes should be well controlled. Having poorly controlled diabetes affects the body’s ability to recover from surgery in more than one way. It increases a patient’s likelihood of hypo or hyperglycemic episodes, which increase their risks of falls or decrease their ability to heal their incision, increasing the likelihood of infection. All infections such as those of the urinary tract or skin should be resolved and dental procedures taken care of beforehand.
Another aspect to consider is the home environment. Trips and falls often happen at home. Fracture or bone injury after prosthetic joint replacement can lead to lifelong problems. A patient should consider the safety of their home including removing trip hazards such as rugs and objects blocking walking paths. Stairs should be stable and have a railing. Patients should also consider what recovery equipment they may need such as a sling, raised toilet seat, walker or shower seat. Patients will also need family and/or friends to help care for them after a joint replacement. Depending on which joint is replaced, care with bathing, incision care, rides to follow up appoints/physical therapy, groceries/food preparation and medication management will be needed. They will also need someone to be with them the day of surgery and to take them home.
A patient should assemble their personal and medical information which includes making sure their medical chart is up to date with medications, allergies, past surgeries, emergency contacts, insurance cards and legal documents (advance directive, living will, durable power of attorney).
The planning of a joint replacement is a team effort and a patient’s surgical team will help guide the way. The patient’s role is crucial in the success of the team. If the patient is prepared with their questions, reads their documents and is dedicated to the process, their satisfaction with their joint implantation will be much higher from beginning to end.
