The number of hip and knee joint replacements is estimated to grow exponentially in the coming years as the general population ages. Chances are you or someone you know has or will undergo a hip or knee replacement.
These surgeries are extremely successful in restoring mobility, decreasing pain and improving quality of life. However, they also carry risks that can be devastating such as infection, stiffness and instability. To minimize these risks, it is important to be “at your best” before surgery. But what does that mean?
Being “at your best” regarding surgery means minimizing the risk of surgical complications by optimizing factors that are modifiable. These modifiable risk factors include body weight, diabetic control, nicotine use and nutrition status.
Body weight is the most common modifiable risk factor. Obesity has reached epidemic proportions, and medical literature clearly links obesity to joint pain. Weight management and controlled weight loss can improve joint pain and also decrease the risk of complications associated with joint replacement surgery.
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In 2013, an American Association of Hip and Knee Surgeons publication concluded that obese individuals had higher rates of wound complications, infections, repeat surgeries, post operative hip dislocations, increased hospital costs and length of stay compared to non-obese individuals who underwent total joint replacements.
Glucose control is also vital to decreasing surgical risks, especially in diabetics. There are no formal recommendation by the American Diabetes Association on optimal Hemoglobin A1C levels in patients undergoing elective surgery, but it has been suggested that A1C of less than or equal to 7 percent is optimal to minimize post-operative complications. Perhaps more importantly, tight blood glucose control in the period around planned surgery has produced fewer complications such as infection and wound complications.
Similarly, nicotine use contributes to delayed wound healing and wound complications. Nicotine constricts arterial blood flow to the surgical site, hindering delivery of nutrients required for tissue healing. Therefore, any product containing nicotine — cigarettes, nicotine patches, nicotine gum, vaping equipment, etc. — are detrimental to ensuring a good surgical outcome.
Finally, nutrition status influences surgical outcomes by regulating the body’s ability to fight off infection and heal. Eating a well-balanced diet rich in fruits and vegetables is key to maintaining appropriate nutrition levels to optimize healing after surgery.
Being “at your best” before surgery provides you and your surgeon the best opportunity to achieve a successful total joint replacement.
Dr. Matthew Luckett, an orthopedic surgeon with Baptist Health Medical Group Orthopedic Surgery, practices at Baptist Health Lexington.