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5 Things to Do Before Going in for a Joint Replacement Surgery
25 March, 2016
- Diabetes: Uncontrolled diabetes is a high risk for any surgery. I routinely see the surprise on my patients face when I refuse surgery for uncontrolled diabetes! For every single diabetes patient the fasting and post lunch sugar in the normal range means “a well-controlled diabetes state”. FALSE. It is exactly like calling Sachin Tendulkar a poor batsman if he gets out after scoring a duck! We see Sachin’s average before proclaiming him as one of the greatest batsman. Similarly we see 3 months average sugar before we decide to go ahead with a surgery. This test is called HB1Ac or Glycosylated hemoglobin. This tells us how badly your body (tissues to e specific) is loaded with sugar. The more the number higher the risk. We surgeons generally prefer a patient with an HB1Ac levels of 7.5 or below for an elective surgery. For urgent or emergency surgery like a fracture repair of course we go ahead and operate though the risk of complications is higher for obvious reasons.
- Blood thinners: A lot of patients now days are on drugs like aspirin or clopidogrel. These drugs make your blood thin and prevent clots. Typically patients with a risk for a heart attack or astroke are put on these drugs. These drugs not only interfere with blood clotting during surgery but also complicate the anesthesia process. For plannedsurgeries it is worthwhile discussing your drugs with your doctor. Generally we stop Aspirin 3 days prior and Clopidogrel five days earlier. Some of the patients can’t be taken off these drugs even for a day and for these patients a different drug protocol is used. We surgeons routinely discover these issues after the patient gets admitted and this leads to postponement of surgery and a lot of misunderstanding.
- Allergies: We routinely ask for allergies and patients feel we are asking for a “drug” allergy. Some patients enthusiastically list even food items they are allergic to! One of my patients developed a lot of blisters after her knee joint surgery. We were worried and then in sheepish tone the patient informed me that she was allergic to the adhesive found in the sticky tape we used for her dressing.
- Exercises: Most of our orthopedic surgeries would involve post surgery physiotherapy or exercises. It always helps if you ask your doctor what kind of exercises would be required. Joint replacement surgeries are planned surgeries and hence if you start practicing those exercises once you are in the planning stage of surgery you typically will do well post surgery. Early mobility leads to significantly low complications after surgery.
- Home care: Your home surroundings are very important. I operated my own professor and when I went to see him 7 days after surgery at his residence, I was horrified when I saw a urinary catheter dangling on his lap. He then told me an interesting fact. His bedroom had an attached toilet but it had a big step which he could not negotiate with the walker we had given him. He elected to get a catheter inserted. Being a doctor even he was surprised when I mentioned to him that he could have temporarily used a commode chair. A catheter mind you can lead to infection in the urinary tract and should be avoided if possible. If he had mentioned his home issues in details we could have offered guidance about these small but very important issues.When one gets operated for a lower limb surgery, it is often difficult to getup from low seating positions, even a simple toilet seat. We get commode extensions easily to navigate these difficulties.