Improving Total Knee Replacement Surgery Results: Optimize Risk Factors PreOp

One way of improving the results of Total Knee Replacement Surgery is to optimize the risk factors. The common patient risk factors include the following: uncontrolled diabetes (Blood Sugar >150, HbA1C>8), Smoking, Obesity (BMI > 40), Opioid use, and Kidney disease. All these risk factors should be corrected prior to having the surgery.

There are treatments available to reverse these risk factors. Uncorrected, the above listed factors increase the chance a patient will suffer an prosthetic joint infection, a return to the operating room for another knee procedure, wound healing problems, revision knee surgery or an unsatisfactory surgical result.

Knee Replacement Surgery Risks

Like any other surgery, total knee replacement carries some risks. However, the occurrence of these risks is quite low: infection, nerve damage, stroke or blood clot. The aforementioned risks are those that might occur during or after the surgery. What we are going to focus on are the factors that might affect the outcome of the surgery. Such factors or risks must be corrected before the surgery is conducted. They include the following: uncontrolled diabetes, smoking, obesity, opioid use and kidney disease.

Uncontrolled Diabetes

• The Risks

According to a number of studies, people with diabetes face a higher risk of postsurgical complications. The possible complications that a patient may experience if he/she undergoes a surgery such as total knee replacement with uncontrolled diabetes are the following: joint loosening, fracture around the implant, blood clot, stroke and wound infection.

• The Treatment

Diabetes is an important consideration before a patient undergoes a surgical procedure. The research suggests that patients need to control their diabetes before undergoing a major surgery such as total knee replacement. While your blood sugar will be tightly monitored right before and after surgery, it’s up to you to make the long-term lifestyle changes necessary to ensure you get the best outcome. This is an important conversation to have with both your surgeon and the physician or provider who helps you manage your diabetes. Eating well and exercising (if appropriate and with approval from your providers) can help you get your body ready for surgery.

Smoking

• The Risks

Research shows that there is a correlation between smoking and the success of knee surgery. Some studies put the chance of redoing the surgery at a rate ten times higher in smokers than in non-smokers. Smokers also show higher rate of surgical complications which include blood clots, kidney problems, urinary tract infections, and abnormal or irregular heartbeats. This is because nicotine constricts the blood vessels, which interfere with and affect the healing process.

• The Treatment

The best way to get rid of the risks is to quit smoking. You may have tried to do so in the past and not found success, but if you’re going to have total knee replacement surgery, let this be the big push you need to finally quit. In addition to the possibility of increased post-surgical complications, just imagine trying to find a place to smoke while you’re recuperating. Talk with your primary care provider about available techniques and support.

Obesity

• The Risks

Obesity is the root of various health conditions and diseases like type 2 diabetes, obstructive sleep apnea, cardiovascular diseases, hypertension and metabolic syndrome.  All these conditions increase the risk of knee replacement surgery. Aside from these, patients with obesity are also more at risk to experience the following postsurgical risks: blood clots, difficulty breathing, poor and slow wound healing, infection and pulmonary embolism.

• The Treatment

To lower the risks and to promote a better result, patients with obesity are advised to lose some weight. It is important that the patient is in good health and weight prior the surgery. Try hard to lose some weight and eat healthy before the scheduled surgery. Your immediate post-surgical health will improve—and along with your new knee, being in better shape will give you a new lease on life.

Opioid Use

• The Risks

One of the total knee replacement precautions a patient must know concerns opioid use.  One study showed chronic opioid use before a total knee arthroplasty led to worse outcomes for patients, including “longer hospital stays, more postoperative pain, and higher complication rates… [patients] were also more likely to need additional procedures, require referrals for pain management, suffer from unexplained pain or stiffness, and have lower function and less motion in the replaced knee.”

• The Treatment

The FDA suggests that patients undergoing knee replacement surgery should decrease the duration and amount of opioid use. There are many other pain management treatments available besides opioids, and you should explore them with your pain management physician—not just because of your surgery, but because chronic opioid use itself brings a whole host of problems you don’t want.

Kidney Disease

• The Risks

Patients with kidney disease, particularly chronic renal disease, have increased risk for readmission after the surgery. The success of knee replacement surgery is also low and the occurrence of common complications is high among patients with kidney problems.

• The Treatment

If you have kidney disease and need to have surgery—any kind of surgery—you and the doctor managing your disease, as well as the surgeon, need to work closely together to assess your risk and make sure surgery is the right course for you. If you and your providers move ahead, techniques like post-operative dialysis, substituting or changing the normal dose of medications like antibiotics given before and during surgery and avoiding pain medications that are known to cause problems are all good strategies to keep you healthy.

Reducing Total Knee Replacement Complications

We, the patient and the doctor, both want something in common. That is, the best outcome possible of the surgery. Knowing how to reduce the complications is powerful information. It is very important that you follow the tips mentioned in this article and control the risks mentioned to improve the results of your total knee replacement surgery.

If you’re contemplating knee replacement, schedule an appointment to see me and the rest of the team here at Advanced Knee Care. Assessing your needs and the appropriate treatment for you is our top priority.