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Total Knee Replacement Preparing for Surgeory
It is important that one maintains optimum general health before a knee replacement surgery. It is important to control high blood sugar and blood pressure before surgery as they can increase the risk of not only infection but also of other complications like those of heart and kidney.
It is important to not have an infection in any part of the body before a joint replacement surgery especially any caries tooth or urinary infection. Nail care is often neglected it is important to keep toenails in proper hygiene when planning for a knee replacement.
Since there is no concept of primary care physicians in India and many surgeons do not bother to optimize their patients before surgery, it is critical to discuss with your surgeon about health optimization before a total knee replacement.
According to National Family Health Survey 4, approximately 50% of women are anemic and about 36% of adult women are overweight in urban India in Tamil Nadu one of the states with good health care in India (http://rchiips.org/nfhs/pdf/NFHS4/TN_FactSheet.pdf). There is a tremendous amount of chronic medical problem burden in India, which can affect the outcome of a knee replacement. To begin with, Anemia, Hypertension and Diabetes have to be optimized before a knee replacement surgery.
Even though the present practice with many surgeons is to get the patient admitted and then work the patient up for surgery it is not a healthy practice, to begin with. TKR is an elective surgery and there are correctable factors that can be addressed.
Urine Routine and Culture to rule out infection You should talk to your surgeon and physician regarding the correctable factors and schedule surgery accordingly. Typically, 6 weeks of time is all that is needed to change many of these entities. If you are found to have a Urinary tract infection your doctors will prescribe antibiotics to eradicate infection for a duration of about 1 week. It is always better to have a negative urine culture before a joint replacement surgery.
Anemia- It is the silent beast in the room. Anemia increases the risk of postoperative mortality, Infections, and Myocardial infarctions. It is many times easily correctable and since it is so common it is often neglected. Most patients after a TKR tend to have a drop in Hemoglobin (Hb%) of 2-3 gm% and this could push even patients with normal blood counts into anemia and increases the need for transfusion. The best way to treat this is by prevention. If more than 3 months of time is available then oral Iron preparation can help. But, if you have your surgery scheduled in less than 6 weeks then Intravenous Iron (Iron Sucrose) and Erythropoietin can help in correcting your anemia. Please talk to your surgeon and physician regarding the same
Generally, smoking and alcohol have an adverse effect on health and if you are regularly smoking or consuming alcohol it is wise to stop a week before surgery. Even though this data is not directly related to joint replacement surgery this is important to understand that smoking generally has bad adverse outcome after a major surgical procedure.
The effect of smoking on outcomes 30 days after surgery was evaluated in 520,242 non-cardiac surgical patients. Smokers had the following outcome in comparison to nonsmokers
(Turan, A., Mascha, E.J., Roberman, D., et al. (2011). Smoking and Perioperative Outcomes. Anesthesiology, 114(4):837-846.)
It is extremely important to maintain a complete record of all the medication that one is taking and inform the treating team about the same. It is advisable to stop Aspirin and anti-inflammatory pain medications like diclofenac, aceclofenac, naproxen 1 week before surgery as they can increase the risk of bleeding. One has to generally continue to take BP medications till the day of surgery
Many Indian patients are underprepared with their surroundings after a total knee replacement. It is important to have some basic changes done at home after a total knee replacement
It is necessary to have the commode at home and also have a raised toilet seat installed
A stable chair for bathing
Reaching device that will allow you to grab objects without bending your hip
Handrails in the bathroom for support
Walker for the first few weeks and then walking cane
Surgery is a stressful situation it is important to relax the day before surgery if your doctor has prescribed pre-medication it is important to take it
Do not eat or drink after midnight because it is important to have an empty stomach for at least 8 hours before anesthesia
Please do not shave the surgical area and take a bath with a chlorhexidine impregnated soap the day before surgery