Preparing for a Knee or Hip Replacement Procedure

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Interviewer: In this series of podcast we're talking about knee replacement surgery and hip replacement surgery. We've already done a couple episodes talking about whether its right for you or not and the similarities and differences in the two procedures.

You've gotten to the point now that you've decided to have surgery and you've likely talked to somebody and you have an appointment. This podcast is going to help you prepare once you've decided to have surgery. We're with Dr. Chris Pelt. He's an expert in joint replacement at University of Utah Health at the Orthopedic Center. So what should I do before surgery to make sure it goes as well as possible? I've heard this referred to as prehab.

What Is Prehab?

Dr. Pelt: Prehab is a new concept that we're really trying to optimize patients to get them ready for surgery. Prehab may be including physical therapy to strengthen their muscles and improve their conditioning and get them physically fit so that they're going to have a better outcome after the surgery.

Optimizing Your Chances for Success 

But more than just prehab, it's optimizing patients so that they're going to have a good outcome. And that includes everything from their nutrition, their diet, their mental states so that they're ready to undergo a big surgery, to optimize their family support systems, so that they have adequate resources and people around to help them get through the surgery and the recovery process. It's about optimizing their medical condition. Again, we want to make sure people don't have a complication or a poor outcome. We want to make sure that they have a good chance of healing their wound and not getting an infection.

So if there are risk factors for outcomes that might be impacted by the things like smoking or obesity or diabetes, we want to take the time before the surgery to optimize modifiable risk factors, making sure that we have the best chance of a great outcome. So that might include visiting with your primary care doctor, working with physical therapists or diabetes specialist, weight loss specialist to try to optimize their medical condition.

We want to make sure that they're healthy. They don't have a sickness. They don't have sores or scrapes or scratches on their bodies, something that could be a source to get an infection in their blood stream. Anything that we can do to make sure that they're coming into the surgery as perfectly tuned up as possible is what we're trying to do in the prehab setting.

Interviewer: Because we learned in a previous podcast that infection is one of the big threats of this type of surgery. So some of these things can actually lower your chance of infection.

Dr. Pelt: That's absolutely right. Infection is rare, less than 1%. But when it does happen it can be a devastating complication. So if they are modifiable things that we can do to optimize our health and decrease our chances of an infection, we want to take all of that time and that energy and effort and do that before we go to the operating room.

Joint Academy: Preparing for Your Joint Replacement

Interviewer: And I understand here at the University of Utah that you actually have a class beforehand that helps people prepare for the surgery. Tell me about that.

Dr. Pelt: We have a joint academy that we ask all of our patients to attend prior to a joint replacement surgery. A lot of this helps to set some of the expectations about what is it like to have a surgery. You're going to meet with our physical therapist. You're going to hear about what type of modifications you need to make at home, what kind of things you're going to expect after the surgery from a physical therapy recovery rehabilitation process.

We find this to be a very integral portion of the preoperative period. We want patients to get that education, hear it from the people that are going to be helping take care of them, so that they know what to expect when they have their surgery. And really it does help optimize their outcomes later.

Interviewer: And I think it's important to stress it. It's okay to hear this information two or three times, because there's a lot of it. So the more you hear it the better command you have of it.

Dr. Pelt: You're going to be absolutely inundated with information from the very first visit to our office all the way through the end of this process. And hearing it multiple times really helps to reinforce it. And as hard as we try to tell it to you, to write it down, for you to listen and you're going to miss parts. And you're going to be really I think better off by having heard it multiple times.

The Importance of Having a Support System

Interviewer: And it's integral to your recovery and your quality of life after the surgery that you understand and do a lot of these things. What about family members? We talked about prehab in terms of changing some lifestyle stuff, but family members are important in the recovery too. Talk about that a little bit and how you should prepare them before you go in for surgery.

Dr. Pelt: We talked about the fact that it is a big surgery. So having a social support system is really valuable, actually. It helps you get through it. It also provides you resources. One of the things that we know is that patients have the best outcomes when they're able to return to their own home in their post-operative setting. There's lower risk of complications and in your own home you're going to have a more peaceful setting where you're going to recover well. And you have people around you that love you and are helping you get the best outcomes.

Please bring your family member to your preoperative visit, to your visits with your surgeon, to the visits with your therapist, to the joint academy. Get them involved. The more people that hear it and the more times you hear it, the better off you're going to be and the better you're outcomes are going to be.

Interviewer: Plus also you need to prepare for after your surgery, which we've got a podcast coming up and family is crucial to that recovery as well, just being there.

Dr. Pelt: Again, I think that the family really helps facilitate your optimal care after the surgery. And having them around, someone that can help you, light household chores, housework, maybe preparing some meals for you kind of decreasing the burden of activities of daily living for you while you spend more of your energy recovering. But the good news is, you're going to be up like I said walking, before you leave the hospital you're able to walk stairs, get in and out of cars, walk around the hallway and the nurse's stations.

You're not going to be totally dependent on your family but you're going to want somebody around to be there to support you I think.

Interviewer: Finally let's talk about how you can prehab your house, so to speak, to make sure that it's prepared for your return home after the replacement, because you'd have to change a few things.

Preparing Your Home for Your Joint Replacement Recovery

Dr. Pelt: Most people will have stairs in their house. You can't get rid of stairs in your home. But you can try to optimize the placement of things on similar floors if that's an option. Perhaps you might use a guest bedroom instead of your normal bedroom because it's closer to a bathroom and the kitchen and maybe things are on the same floor. That might not be an option for everybody and it's not mandatory. But things that you can do to simply make it easier for you to co-locate certain things you're going to do throughout your activities of daily living will be helpful.

Removing obstacles throughout the house, maybe you have some bath mats or area rugs that you might want to remove because they might be a risk factor for you to trip on with your walker or your crutches. And also trying to practice using those types of things in your own home before you even have your surgery before you have to come back and try it out. Practice with your crutches, walk around your house a little bit. See how it feels and make sure that everything is looking like it's going to be a good option for you when you get back.

Interviewer: Yeah. Now, that you said that I'm like, That's a great idea but I could see myself feeling like, this is little silly but it probably does make a difference. You probably might see some things you might not realize before.

Dr. Pelt: I think the more you do before you have the surgery and before you get home, the better off you're going to be.

Interviewer: Coming up in the next podcast we'll talk about life after your total joint replacement whether it's in your hip. We'll talk about how will it improve your life, what to expect as far as that is concerned, what to expect with rehab and also what to expect with pain management.

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