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Patient Optimization

For elective joint replacements, it is essential to optimize all possible modifiable risk factors and ensure medical conditions are stabilized prior to surgery. Our goal is to provide you with the best joint replacement experience possible, and to decrease your risk of post- operative complications and provide a smooth recovery.

Nutrition: Proper nutrition is critical to a successful surgery and post-operative recover. A high protein, anti- inflammatory diet has been correlated with improved outcomes after total joint replacement. Here are a few guidelines: (if your PCP or other physician has you on a specific diet, you should continue to follow that)

-Recommended Foods: fish, nuts, seeds, fruits, vegetables and whole grains

-Consume 100g/day of protein (unless medically advised to have low-protein diet)

-Foods to avoid: red meat, sugars, saturated fats, simple carbohydrates, fried food, processed foods

Blood Disorders: Your blood will be drawn prior to surgery. Please inform your surgical team if you have a history of anemia or blood clotting or bleeding disorder. If your hemoglobin is <12.0 you will be placed on Vitamin C and iron supplementation. If your hemoglobin is < 11.0, we will need to delay the surgery and refer you to a hematologist. Additionally, your platelet count should be >150. 

Diabetes/ Blood Sugar: Uncontrolled Diabetes can lead to increased post-operative complications, especially post- operative wound complications and prosthetic joint infections. In order to decrease your risk of post-operative complications, we ask that your Hgb A1c be <7.5 (within 3 months) and fructosamine <292 (within 30 days) prior to surgery. Additionally, we recommend daily blood glucose monitoring to keep your daily glucose well controlled (<150), especially around your time of surgery. Bacteria love sugar, and high glucose levels in your blood can put you at higher risk for infection!

Body Weight/ Obesity: Maintaining a healthy body weight is important, both for your overall health and your post- operative recovery. In fact, for each pound of body weight, there is up to a 3-5x amount of force transmitted to your joints, particularly with ascending or descending stairs. Healthy food choices, portion control and daily activity are important to keeping your weight in a healthy range.

Studies show that in patients with a body mass index (BMI) >35 there is a significant increase in post-operative complications, especially infection and development of a blood clot. This is exponentially elevated in patients with a BMI >40. Because of this, and in order to protect our patients, at The Everett Clinic we are limiting joint replacement surgery to patients with a BMI < 40. If your BMI is >40, you will need to have a weight check prior to surgery. Please also discuss with Dr Vaux or Megan Hebda, PA if you would like a referral to a weight loss clinic or nutritionist, such as the Northwest Weight Loss Clinic, in order to discuss strategies to safely lower your body weight and BMI.

Smoking: Smoking has been shown to increase post-operative complications after total joint replacement. Studies show there is a decreased rates of surgical site infections, blood clots, pulmonary embolism, pneumonia, stroke and UTI in patient who stop smoking prior to surgery. We ask that you stop smoking (and all nicotine products) prior to surgery. You will also need a negative Cotinine test to confirm your nicotine levels are appropriate for surgery. We also recommend that you continue smoking cessation for at least 4 weeks after surgery in order to decrease the risk of wound healing complications and provide the best outcome after your joint replacement.

Alcohol Use: Before surgery, it is important to be honest with your surgical team about your alcohol use. Please disclose accurately how many drinks you have per day (or per week). This information helps determine if you are at risk for alcohol withdrawal or other alcohol-related problems that could occur after surgery and affect your recovery. Our goal is to help you prepare and recover from your surgery as quickly and safely as possible.

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