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Optimizing Your Outcome From Total Joint Replacement

May 5th, 2020

Authored by Michael Miller, PAC

Happy elderly couple riding bicyclesDeciding when to have a joint replacement is an important decision, but one that can lead to improved quality of life for many years. Our goal for your total joint replacement is for you to return to your desired activities of daily living including walking, climbing stairs, driving, traveling, yard work and low impact sports. We strive for your satisfaction, and its rewarding to routinely have patients tell us after their surgery—“this is the best thing I’ve ever done,” or “why didn’t I do this years ago?”

There have been countless studies aimed at determining what factors invoke this level of happiness and end up with what we look at, as an Optimal Result. Here are some key areas the studies looked at:

  1. How bad or limiting is my knee/hip?

    One study demonstrated that those more affected by their joint pain saw greater improvement after surgery and were thus, more satisfied. If everyday activities are severely limited or if you have a noticeable decline in function, there is a greater chance you will see significant improvement, post operatively. In short, the more you are limited by your joint pain, the more likely you are to be happier with your outcome after your replacement.

  2. How high are your expectations?

    Another study concluded that those who had higher expectations prior to surgery were typically more satisfied with their results. It is important to understand the limitations of your total joint replacement by reading the information provided by your surgeon and having a conversation about realistic expectations. For instance, it may not be advisable to run marathons going forward but you could take a weeklong bike trip through Europe.

Preparing for Joint Replacement Surgery

Now that you have selected the best surgical team and facility for you, it is time to do some self-reflection and determine what changes or choices you can make to ensure the best outcome. We have found that patients who educate themselves preoperatively and take an active role in their preparation for surgery & recovery, yield greater satisfaction after their surgery.

  1. Bodyweight

    Most patients who suffer from severe osteoarthritis are overweight. Even a few pounds can make a difference; if you are just 20 lbs overweight, losing weight preoperatively typically leads to an easier recovery with decreased pain and increased function. Three to five times your bodyweight is stressed through the hip and knee joints with everyday activities like stairs or getting in and out of a car. For every 1 pound loss, your joints can see a 3-5 pound benefit. Lose ten pounds and your knee feels 50 pounds lighter.

    Dr. Dalury has implemented with the consultation of our anesthesia team a BMI (Body Mass Index) requirement before scheduling surgeries. This optimum BMI is under 40 kg/m2. Patients over a BMI of 40 are at a higher risk for wound healing issues and thus infection. They have also been found to have higher risk of blood clot and intraoperative complications. This BMI goal ensures the safety and success of our patient’s total joint.

    We understand that with severe arthritis your ability to exercise can be greatly compromised. You don’t have to do it alone. Speak to your primary care physician about weight loss options. We also have resources available that may be covered by your insurance plan.

  2. Blood sugar in diabetic patients.

    Our patients are instructed to ensure that their diabetes is well controlled and their primary care physician deems their hemoglobin A1C is appropriate. Elevated A1C levels and blood sugar numbers around the perioperative period have been shown to greatly affect wound healing and subsequently increase infection risks. If these numbers are found to be too high, we unfortunately may be forced to postpone your procedure.

  3. Tobacco cessation

    Nicotine usage adversely affects blood flow to your tissues and thus hampers or prevents wound healing. Research has shown that stopping tobacco products for as little 2-4 weeks prior to your procedure and continuing the cessation during recovery is essential.

  4. Preoperative exercise and/or physical therapy

    One of the most costly and time consuming parts of your surgical journey will be physical therapy. Insurance companies unfortunately dictate how many sessions or what benefits you may receive regardless of your surgeon’s recommendations. Many of our total hip patients will not need aggressive hands-on outpatient therapy and can do the provided exercises in the comfort of their own home. Many of our knee patients will require 4-8 weeks of supervised therapy. Patients who complete a preoperative exercise regimen that both familiarizes them with the exercises and builds strength and stamina will benefit post operatively. On this page you will find videos that prescribe particular exercises that can be done with minimal or no equipment.

  5. Reduction or cessation or narcotic pain medication

    Arthritis is a painful and debilitating condition that unfortunately forces some patients to rely on narcotic pain medications to manage. Research has concluded that patients who are on preoperative narcotics require much higher dosages of post-operative medications and have poorer outcomes. It is not advisable to stop these pain medications “cold turkey” but talk to the prescribing physician whether it be a pain management specialist or your primary care provider about a plan to reduce usage or stop.

  6. Depression and anxiety

    One of the least talked about factors regarding surgical outcomes is the role of depression and anxiety on overall surgical satisfaction. Those suffering with these issues have higher rates of dissatisfaction and complications. One in six Americans now takes prescription depression/anxiety medications and far more go untreated. If you have feelings of sadness, despair, hopelessness or anxiety, speak to your doctor about therapeutic options that may or may not be pharmacological. If you have not suffered from these issues in the past, sometimes a major life event or stressor such as a total joint replacement can bring on these feelings. As we regain our independence and ability to perform daily tasks, these feelings typically subside. If you these feelings persist, we highly recommend speaking to your family physician.

  7. Build your support team

    Attempting to go through this journey alone is a daunting task, but by no means impossible. If you can, however, try to find a family member or friend that will be there to aid you with the recovery process. Educate them with these materials so they know what to expect. Bring them with you to a preoperative and postoperative appointment. Ask them to join you at the joint class. Turning to a loved one during this important time will help you to navigate this surgical journey both physically and emotionally.