In this post, I’ll discuss the importance of “getting in shape” for surgery. When conservative nonsurgical measures fail, and we’re considering joint replacement surgery for the treatment of end stage arthritis of the hip or knee, it’s important to take measures to increase your chance of success and reduce the risk of complications. Ideally, these steps should take place well before the actual procedure, and can be compared to “training for a marathon”. Generally, we look at three things in particular: Are you close to your ideal body weight? Are you aerobically conditioned? Are you a nonsmoker? If the answer to each of these questions is yes, you’re probably an excellent candidate for surgery. If not, we suggest that you take the following steps prior to scheduling surgery:
Being at or close to your ideal weight enhances your chances of surgical success. (You can calculate your BMI here.) If your BMI is 30–39, you have a higher risk of complication from surgery. If your BMI is 40 or above, you may not be a candidate for surgery right now, but we have resources at Emory to support you in your weight-loss efforts. Emory Family Medicine offers weight-loss counseling services, and the Emory Bariatric Center provides both surgical and nonsurgical weight-loss options. Weight loss is among the most important steps toward improving overall health and quality of life. In most cases, weight loss will improve the pain and loss of function associated with arthritis of the hip and knee. This improvement can be significant enough to obviate the need for surgery. If surgery is necessary, appropriate weight loss prior to surgery will dramatically reduce the risk of complications including infection and dangerous blood clots. In addition, it will speed the recovery process and help prevent future orthopedic problems.
Patients who exercise regularly tend to recover from surgery more quickly than patients who don’t. If you’re preparing for orthopedic surgery such as knee or hip replacement, weight training and cardiovascular exercise can smooth the recovery process. When your muscles and soft tissues are strong and well conditioned, they help stabilize the knee and protect the joints, helping you get moving again more quickly.
Further, if you‘ve been diagnosed with hip or knee arthritis, don’t discontinue exercise and aerobic conditioning. Exercise has been scientifically proven to improve the pain and loss of function associated with arthritis of the knee. If you aren’t currently active, you can start now by slowly introducing exercise into your schedule—even just three times a week is helpful. Choose an exercise that does not cause pain. In general, lower impact exercises such as swimming, cycling, and the elliptical machine will allow elevation of heart rate while minimizing pain associated with hip or knee arthritis. There’s no evidence that increasing activity level will cause worsening of knee arthritis.
If you need help creating an exercise plan, the physical therapists at the Emory Orthopedics & Spine Center can work with you. Having professional support and/or a partner to exercise with can make it easier to begin and stick with an exercise program.
Smoking cigarettes increases the risk of complication after orthopedic surgery. If you’re a smoker, cessation from smoking for at least one month before and one month after surgery can significantly reduce the risk of complications after surgery. Smoking can inhibit bone’s ability to heal itself, slow surgical wound healing, and increase the risk of infection following surgery. Smokers also have an increased chance of having lung problems, such as pneumonia, after surgery. One study demonstrated that smoking cessation prior to and after surgery could reduce the risk of complication by more than 50%.
If you need help quitting, Emory Family Medicine offers smoking cessation counseling services.
Are you getting in shape for orthopedic surgery? We welcome your questions and feedback in the comments section below.
Thomas Bradbury, MD, is an assistant professor of orthopedic surgery. He holds clinic at Emory Orthopaedics & Spine Center at Executive Park and performs surgery at Emory University Orthopaedics & Spine Hospital (EUOSH). Dr. Bradbury’s professional goal is the improvement in quality of life for patients with pain secondary to hip and knee problems. He started practicing at Emory in 2007.