Dreaming of skipping up a flight of stairs again pain-free? You’re not alone. Knee and hip replacements are among the most common surgeries in US hospitals, with about 700,000 and nearly 400,000 procedures, respectively. Why? The obesity trend is one culprit, but so is the desire to lead an active lifestyle. People want to hike, golf or play tennis well into their retirement years, and surgical advances have made that possible.
Since most knee and hip replacements are elective surgeries, you have the luxury of taking your time to choose the right doctor and hospital, as well as the time to optimize your presurgical health, all of which can make a big difference in your recovery. My inside secrets on how to do both…
Choose the right team
It may be convenient to have your joint replacement done at the local community hospital, but a large orthopedic hospital or university teaching hospital is a better option. These doctors perform many more surgeries, plus these centers are where the thought leaders are, so you can benefit from the latest advances, state-of-the-art equipment and a team of specialized professionals beyond the surgeon to support you every step of the way.
Presurgery Preparation
Patients who are the healthiest going into surgery have the best outcomes, so you want to do everything possible beforehand to make yourself a safe candidate. While that can take several months for some, it’s worth it to reduce the risks. At Yale Medicine, we have a checklist of modifiable risk factors that we use to help patients overcome, including…
Excess weight: Being overweight or obese increases your risk for complications, such as infection and delayed wound healing during surgery and postsurgery, and simply makes recovery more difficult. We like patients to have a body mass index less than 38. For patients at an unsafe weight, we provide nutrition counseling to teach them to eat healthier and drop pounds gradually for sustainable weight loss. For patients unable to exercise due to severe arthritis pain or who struggle to lose weight through diet alone, we might recommend bariatric surgery.
Poor diet: Even if you’re at a healthy weight, we want to optimize your diet. Adequate nutrition and vitamin reserves sourced from protein, fruits and vegetables help you recover faster and heal your incisions. I have my patients eat an egg every day for two weeks prior to surgery to ensure that they have enough protein stores. If you suffer from anemia, low blood counts or low iron, we may also suggest that you take some vitamins to improve that, such as iron, folate, B-12, calcium, vitamin D and vitamin C, and perhaps a protein supplement. Any supplements should be coordinated with your primary care doctor.
Exercise: Conditioning with a physical therapist before surgery helps strengthen muscles and improve balance so that you recover faster. This is especially important if you are using a cane, walker or wheelchair before surgery. Increasing your mobility presurgery helps reduce your risk of falling and improves postoperative pain control.
Substance use: Patients need to wean off narcotic pain medications, alcohol dependency, tobacco and other recreational drugs prior to surgery, and we provide counseling for that. Tobacco use increases your chances of postsurgical lung complications and infection and delays wound healing. At Yale, we have a strict policy that patients must stop smoking for at least eight weeks before surgery.
Even if you drink alcohol only in moderation, you should avoid it altogether two weeks prior to surgery. Alcohol increases your risk for complications such as poor wound healing, lower immune response, poor liver health and poor nutrition.
Dental care: Have a checkup, cleaning and any necessary dental work done prior to your surgery. Bacteria in your mouth can travel through the bloodstream and would be attracted to your joint implant, increasing your risk for infection. Patients should wait around six months after their joint replacement to have any other dental work.
Be proactive postsurgery
Many knee- and hip-replacement patients go directly home the day after the surgery—and some even go home the same day. We have found that patients recover faster, have fewer complications and are happier if they are discharged to home rather than a rehabilitation facility. Enlist family and friends to help you at first, including stocking your refrigerator and cooking meals and for transportation to doctor appointments. A strong support system also promotes healing.
Physical therapy: Getting moving again is the most important thing you can do to reduce inflammation, swelling and pain. You’ll start with a walker and progress to a cane. Usually patients do away with these devices by about four weeks. The physical therapist at the hospital will teach you specific exercises. Depending on your insurance, you will continue with physical therapy either at home or at an outpatient rehab facility. For the fastest and best recovery, perform your routine for 20 to 30 minutes two to three times daily. You’ll also need to walk (with your walker or cane as needed) another 60 to 90 minutes daily. Don’t worry about distance—the number of times you walk is more important than how far.
Pain relief: Less pain helps you heal faster, but at Yale and other leading surgical centers, we champion a narcotic-sparing approach due to the dangers of opioid pain relievers. We use peripheral nerve blocks during surgery to help reduce pain afterward and give acetaminophen (Tylenol) intravenously, which provides better pain relief than taking it orally. Once home, patients may be prescribed acetaminophen, a nonsteroidal anti-inflammatory (such as ibuprofen) and gabapentin (Neurontin), a non-narcotic neurological medicine that can help reduce pain for two to three weeks. Your goal should be to taper off narcotic medication by the end of the second week after surgery and take acetaminophen or an NSAID only as needed.
Diet: Follow the same high-protein, fruit- and vegetable-loaded eating plan as you did before surgery. It can be hard to eat while you’re in pain, but your body requires adequate calories to help it heal after surgery. Avoid sugar and refined carbs, both of which can increase inflammation and slow healing.
