Risks of Joint Replacement Surgery | Richardson, TX
All surgical procedures entail risks, regardless of surgery for removal of an appendix, cosmetic procedures, or orthopedic procedures for realignment of a broken bone. Surgical procedures often require general or regional anesthesia, postoperative care, and the skill and attention of the surgeon and surgical team during the procedure itself. Such risks can include bleeding during or after the procedure, damage to any of the nerves or blood vessels around the surgical site (or even far away from it), blood clots or infection after the procedure, postoperative pain, and risks associated with anesthesia. Anesthesia risks can include everything from reaction to medications before, during or after surgery, or the more serious risks of stroke, heart attack, or even death.
When it comes to the surgical replacement of a hip or knee, it is useful to remember that joint replacement surgery is an elective procedure. Not that it isn’t necessary, but “elective” refers to the fact that it’s not an emergency; the procedure can be scheduled at a point of convenience or once various risks have been minimized. This helps to tilt the scales in the patient’s favor and reduce the chances of a complication during or after the surgery.
Modifiable vs Nonmodifiable Risks of Joint Replacement Surgery
Surgical risks can be classified into “modifiable” or “nonmodifiable” risk factors; that is, those that we cannot do anything about and those that we can. For example, age would be considered a nonmodifiable risk factor since we can’t turn back the clock (although some might want to). An example of a modifiable risk factor would be a medication for another medical problem such as a skin problem that might increase the risk of infection. Stopping the medication at a given point before a joint replacement could help to mitigate that elevated risk of infection; something you would definitely want done before embarking on a major joint replacement surgery like hip or knee replacement.
Given that we have factors that can be changed to improve a patient’s chances for a good outcome, we surgeons obviously want to do all that we can to address any and all modifiable risk factors prior to going to the OR to replace a hip or knee. If patients are on medication for other medical conditions, we want to review these and make sure that the medical conditions themselves are well controlled and that the medications do not need to be changed or stopped prior to the joint replacement surgery. In diabetics, for example, we would make sure that indicators of diabetic control indicate that the diabetes is well controlled and if not, see that it is before undergoing surgery. The same for patients with heart or lung problems. There are two modifiable risk factors that deserve specific mention. These are tobacco use and excess weight.
Using tobacco, especially cigarette smoking, has numerous deleterious effects on surgical patients. Nicotine, found in tobacco products, is a vasoconstrictor. That is, it narrows blood vessels. This can impede blood flow to healing tissues and result in wound complications. Not a good thing when it comes to a surgical wound freshly stitched together that you would want to heal. Tobacco use has also been associated with an increased risk of blood clots and pulmonary embolism (blood clots that go to the lungs). Add in the increased risks of peripheral circulatory compromise, stroke, and heart attack, and cigarettes are just not a good idea to mix with joint replacement surgery. And since we don’t have to perform the joint replacement surgery until and unless all risk factors are minimized, we require that patients stop all tobacco use before an elective hip or knee replacement. Longer is better, but for at least 60 days before your joint replacement surgery, no cigarettes.
Weight is a more difficult subject. Not just because weight loss itself is difficult, but patients can become stigmatized and feel slighted because of excess weight. In most cases, being overweight is not a new problem; it’s something a patient may have dealt with for many years, in some cases even since childhood. The very word “obese” causes some people to become automatically defensive. They deny their condition, and worse, many think that if they could “just get their knee/hip replaced” they could lose the weight.
In truth, obesity is a medical condition. No one wants to have high blood pressure or eczema, but some patients have these conditions and they can improve with treatment, or they can be ignored and get worse. The same goes for obesity. Obesity is a nationwide epidemic, and becoming worse on a regular basis. The Body Mass Index (BMI) is a calculation that takes into account a person’s height along with their weight to give a numerical indicator of where they fall in regards to underweight, ideal weight, overweight, or obese. A BMI greater than 35 is considered obese. Patients who have a BMI in excess of 35 have a greater risk of infection following elective joint replacement surgery. And any patient who develops an infection following joint replacement surgery will be unlikely to have an eventual outcome as good as a patient who does not develop an infection, and so we surgeons take the risk very seriously.
Infection is one of the most serious complications of joint replacement surgery, and patients and surgeons alike would do well to do all things possible to minimize the risk. However, excess weight and a higher BMI also invites additional risks. Another major complication following joint replacement surgery is loosening of the implant, even without infection (so-called “aseptic loosening”). In overweight patients, the rate of this complication is greater than those whose BMI is less than the cutoff of 35. Similarly, the risk of blood clot or pulmonary embolism is greater among overweight patients compared to their lighter counterparts.
In those patients with excess weight, surgeons should do all that they can to help the patient. Just as one would get a patient into the care of a cardiac specialist for a heart issue, referral to a specialist in the area of weight loss can help to reduce the modifiable risk associated with excess weight. In cases of joint replacement surgery patients who are significantly overweight, a weight loss specialist can prescribe medication, offer nonsurgical adjunctive remedies to help with weight loss, and many times offer surgical intervention for weight loss where needed. And, fortunately, most insurances have begun to acknowledge that helping fight excess weight is in everyone’s best interest by covering the cost of medications and even surgery for weight loss.
Addressing modifiable risk factors is an important component of preparing for a successful joint replacement surgery. Avoiding tobacco and obtaining an ideal weight are critical among these factors amenable to change. After all, following the surgery, there are other joints that will continue to benefit from avoiding cigarettes and from less wear and tear that results from weight loss before ever going to the operating room.