Existing Risk Factors that Should Make you Reconsider Joint Replacement Surgery

The risk factors that contribute to a poor and unsatisfactory result from any joint replacement surgery include, but are not limited to, the following list:

• Diabetes
• Especially patients with poorly controlled blood sugars.
• Insulin-dependent diabetes of long-standing.
• Neuropathy of the leg
• Chronic numbness and loss of sensation below the knee.
• Feelings of imbalance and gait disturbance from loss of nerve function.
• Loss of feeling in the feet, so that cuts and ulcers cannot be felt.
• Obesity
• Especially if accompanied by chronic swelling of the legs and ankles.
• Especially if there is redness or color change in the area above the ankles.
• Especially if the skin has the consistency of an orange peel.
• Heart disease
• Severe heart disease may preclude any major surgery.
• A clearance by a heart doctor is essential in all other cases even if a mere suspicion of heart disease exists.
• Depression
• Very unlikely that major joint surgery will improve this condition.
• Better to treat this problem first.
• Depression and other related mental conditions will make recovery after joint replacement surgery very difficult.
• Unusual pain response and narcotic use
• Joint replacement surgery hurts in all cases. If you have low pain tolerance, or have tolerated any previous surgery poorly in terms of pain relief, you should not have the procedure done because follow-through with rehabilitation will be hard.
• Use of narcotics and other strong pain killers before the surgery means that these drugs will not work after surgery. If you have developed a dependence on such such medications, do not have joint replacement surgery unless this problem is addressed first.
• Smoking and Alcohol Use
• Smoking cigarettes will compromise healing after any surgery. Heavy smoking also contributes to lung, heart, and other medical problems, all of which make recovery that much harder. It is best to try to quit smoking, at least to ensure that your recovery from joint replacement surgery is not compromised.
• Heavy alcohol consumption, such that you have trouble with balance, or have had withdrawal, or seizures, or alcohol-related medical problems such as liver disease will preclude a successful result after any joint replacement procedure. Social or moderate alcohol use of course is a different story, and it is not a contraindication to successful joint replacement surgery.
• Minimal arthritis on X-rays. If the arthritis is not severe enough, then:
• Better to try anything else to relieve pain.
• Joint replacement is most successful when arthritis is severe.
• Patients who are eager to have joint replacement surgery, and short-circuit the conservative steps in treatment are usually dissatisfied with the results.
• If need be, we can do an arthroscopic procedure to look inside the knee or hip joint to confirm the extent of arthritis if the X-rays do not tell the whole story. Click here to learn more about arthroscopic surgery and its outcomes in such situations.
• Secondary gain issues
• Patients who desire surgery because of pending litigation, unresolved workers’ compensation issues, or any other reason besides severe pain from proven degenerative joint disease will have a disappointing result.
• Knee-cap pain (also known as patella chondromalacia)
• Pain that is exclusively in the front of the knee, with stairs, kneeling, or squatting may not respond to knee replacement surgery.
• In fact, such pain can sometimes persist to some extent for at least a couple of years even after successful knee replacement surgery.
• Neurologic problems
• Patients who have had a stroke, or have Parkinson’s disease, or Alzheimer’s disease, or any other condition that is expected to gradually compromise their functional status will generally have less than a satisfactory result from any joint replacement procedure.
• Advanced Age
• Although age is not an absolute contraindication to joint replacement surgery, such surgery will never enable a patient to regain any function that is already lost.
• Thus, if a patient is already in a wheelchair, or bedridden, it is nearly impossible to get them walking again simply with a successful joint replacement procedure.
• If the patient’s overall functional status is deteriorating, major joint replacement surgery will not reverse the trend.
• In fact, joint replacement surgery in such a situation might only accelerate the downhill slide and should be avoided.
• The reason for this is that old age, impairment of function, and eventual demise are inevitable for all of us. No amount of surgery can ever change this.
• Young, Active, and Muscular patients
• Please be aware that in general, the young and muscular patients are most likely to have the following outcomes after joint replacement surgery:
• Longer rehabilitation.
• More pain during recovery.
• Difficulty adjusting to a prosthetic lifestyle.
• Some degree of persistent pain even years after surgery.
• Remember that the optimal patient for hip or knee replacement is one who is at least middle-aged, or older, in whom the hip or knee is so deteriorated that it affects pain and function, and who is motivated, and who understands that an artificial joint is a salvage, and only a salvage procedure to substitute for the worn-out joint.
• Any person not meeting this description is likely to have less than an optimal result.
• This does not mean you cannot have surgery, but it does mean that you have to be realistic about expectations and the eventual result.
• Lack of Perception & Self-Awareness
• People who do not take care of themselves will do poorly and usually end up worse as a result of any joint replacement. Please note the following considerations:
• Poor dental hygiene increases the chances of an infection after joint replacement, and this must be addressed before surgery, without exception.
• Poorly managed general health is a very strong indicator of someone who will have a poor outcome from joint replacement surgery.
• A lack of insight into your health, as reflected by poor compliance in taking the steps necessary to prepare for your surgery is almost certain to guarantee a poor result.
• Poor compliance with follow-up instructions, precautions, and the inability to comprehend the long-term effects of having an artificial joint in your body will adversely affect the end result.
• Poor personal hygiene and living conditions will jeopardize the end result. Such conditions are generally associated with an increased risk of infections, and with folks who are unable to take care of themselves.
• Any condition that predisposes your skin to break out frequently, or results in sores and ulcers will increase the chances of a poor result from joint replacement surgery.
• Poor Attitudes
• Hostility, anger, and passive-aggressive behavior are strongly related to an unsatisfactory result after joint replacement surgery.
• Previous negative experiences with the health care profession are associated with poor outcomes after joint replacement surgery.
• Hostile or antisocial behavior are generally associated with poor results after any reconstructive surgery.

If any combination of the above factors is present, or if in our judgment you are not the type of patient who will do well after a hip or knee replacement procedure, we may postpone or cancel the procedure. Please understand that joint replacement surgery is entirely elective, and if there is any doubt as to the outcome on your part or on our part, it is best not to proceed. In rare situations, we may perform a procedure on one limb, and then postpone a similar procedure on a different limb. Like medicine in general, joint replacement surgery is an art, in addition to being a science.

Prior to any surgical procedure, we will assume that you thoroughly understand all material presented in this web site. Please understand that we may cancel the procedure at any time until the surgery, if in our judgment you are unlikely to have a satisfactory result from the surgery, or if the risk of a poor result or an adverse outcome exceeds our safe threshold for performing such surgery. Please feel free to communicate with any of the doctors via e-mail. We appreciate the opportunity to answer any questions that you may have.