Preparing for joint replacement surgery

Joint replacement surgery often involves a long process from considering the procedure with your doctor to the waiting process involved in preparing for surgery. Some may wonder if surgery is the right choice for them, or what they can do to help prepare for their surgery.

Your doctor may discuss joint replacement surgery as an option if your arthritis symptoms have not responded to medications, physiotherapy or lifestyle interventions and if you are a suitable candidate. You might also hear your doctor refer to joint replacement surgery as “arthroplasty”. Surgery is often a last resort when other treatment options have not been helpful. Only a small portion of people with arthritis will require joint surgery.

A joint replacement can be either a total replacement or partial replacement, depending on your specific needs. 

Deciding if surgery is right for you

While joint replacement surgery can help relieve pain and has a high success rate, it is also a major operation with an extended recovery time that requires careful consideration. More conservative management approaches such as therapeutic exercise are advised before considering surgery. Your doctor may consider joint replacement surgery for you if your arthritis causes significant pain or limits daily functioning and other more conservative treatment approaches have not worked. Some things to help you consider whether a joint replacement may be right for you include:

• Not being able to complete daily tasks on your own due to joint pain or physical limitations, requiring the help of a caregiver and/or assistive devices.
  • difficulty climbing stairs, getting up from chairs, sitting/bending over and rising
  • difficulty getting a restful night sleep
• Pain has become worse over time
  • medication isn’t working as well as it once did
  • becoming less active because of pain with activity or exercise
  • Limiting social or work activities due to pain levels
  • Affect on other areas of life: family or friend relationships, work, dressing, eating, walking
• Readiness
  • You and your doctor have tried all other available treatment options
  • physically, emotionally, and mentally able to undergo surgery – surgery and recovery can be very time consuming, and physically intense. Not everyone will be eligible for surgery due to health concerns. Discuss if surgery is an option for you with your doctor. 

The decision to not have surgery and to continue or increase non-surgical treatment options depends on continued conversations between you and your healthcare providers. Some things to consider include:

• Other health conditions that may interfere with your ability to heal or recover from joint replacement surgery.
• Illnesses, infection or other factors that could impact your ability to heal, including smoking, diabetes mellitus, or immunocompromising conditions
• Muscle weakness caused by advanced arthritis and inability to move independently. 

You are a good candidate for joint replacement surgery: What Next?

Understanding the benefits and risks to surgery is an important step for patients to make an informed decision regarding a joint replacement. Have a conversation with your surgeon and primary care team about what you can expect following the surgery, and what types of movement you can expect to have in your joint once you recover, as well the possible risks and benefits to surgery.

The main benefit to surgery for most people includes increased movement and ability to exercise. While recovery varies from person to person, most people with can expect to return to low-impact activities post-surgery. While medications and alternative therapies may offer pain management and temporary relief from stiffness and swelling, surgery is sometimes the only option that can offer more long-term pain relief for many types of arthritis. Surgery cannot cure arthritis, but it can help improve quality of life if you and your doctor decide it is the right choice for you. 

Unfortunately, surgery is not without risks. Complications are a risk for anyone undergoing surgery, however people who are in poor health before surgery are more likely to have complications. Some risks can include infection, joint stiffness, the need for another procedure, continued pain in the joint, loosening or failure of the prosthetic joint, as well as the general complications of any major surgery (for example - blood clots, delayed wound healing, fracture or nerve injury). Depending on the joint, as well as the length of immobility following surgery, these complications may be more or less likely to develop; the most high-risk surgeries are for larger and more weight-bearing joints (for example - hip and knee replacement). The sooner you get moving and return to as many of your usual daily activities as possible, the faster your recovery will be and the more you will reduce your risk of many complications (such as stiffness and blood clots).

I’m having surgery in a few months. What can I do?

If you’re wondering how to make the best use of your time before an upcoming surgery, here are some tips to help you prepare:

• Be informed: Take the time to read through any materials you received from your surgeon or primary care team, and ask questions if you are not sure about something. It can be helpful to write questions down ahead of time to bring to your appointments, so you don’t forget to ask.
• Eat a well-balanced diet: Eating a diet that is balanced with vegetables, protein, and grain can help to maintain a healthy weight. Remember to fill half your plate or bowl with vegetables, one quarter with protein, and one quarter with whole grains or starchy vegetables. 
• Exercise: Consider seeing a physiotherapist or exercise trainer, or join a walking or exercise group to engage in low-impact, low- to moderate-intensity exercise. Ask your doctor about any recommended exercise to strengthen your joints and muscles. The stronger your muscles are and the better shape you are in before surgery, the faster and better your recovery will be.
• Stop Smoking: If you are a smoker, stop smoking at least six weeks before surgery. People who smoke have a higher chance of surgical complications and are at a greater risk for infection, blood clots, heart attack or stroke after surgery. Ask your doctor for resources such as a smoking cessation kit, referral to a support group, or therapy if you are having difficulty with this process.
• Stay up to date on vaccines: Make sure you are up to date on all your vaccines, such as tetanus, seasonal flu, COVID-19 and any others your health team recommends for you. 
• Plan ahead for recovery care: After surgery, you will need someone to help you get home, and you may also need help to prepare meals, dress or move around as you recover. Consider asking a family member or friend to help you with your daily activities following your surgery.

I’m having surgery in a few weeks. What can I do?

• Plan ahead: for at least a few weeks after surgery, daily tasks may be challenging. While most surgeons will recommend moving around as soon as possible, you can make the recovery process easier by preparing batch meals to freeze ahead of time, planning out transportation and any personal care help you might need, as well as re-organizing the layout of your home to make it easier to navigate after surgery.
• Do your best to stay healthy: an illness leading up to your surgery may impact your ability to safely have surgery and may cause a delay. If you develop any fevers, infections or open sores, make sure to call your doctor or surgeon. Be sure to wash your hands regularly and follow local health guidelines for any illnesses going around (i.e., seasonal flu, COVID-19) 
• Medication: your doctor or surgeon will let you know what modifications need to be made to your medication schedule if you are on one. This may include stopping any blood-thinners or anti-inflammatories as well as opioid or pain medications in advance of your surgery. Be sure to bring your medications with you to your pre-surgery appointments.

I’m having surgery in 24 hours. What can I do?

• Showering and hygiene: follow you doctor’s instructions about showering before surgery. You will be asked to use a special soap with your shower to help prevent infections. 
• Do not shave any area near the joint that will be replaced. Any cuts to the skin pose a threat of infection, and your surgical team will want to minimize this risk. If any body hair needs to be trimmed for the surgery, this will be done in the operating room. 
• Eating and drinking: Generally, you will be asked not to eat solid food after midnight the night before your surgery. You can usually continue to drink water and other clear fluids (e.g., apple juice, ginger ale, sports drinks) until a few hours before your surgery. Keeping hydrated before surgery is important and can help with your recovery. This may not be possible for everyone, so talk with your surgeon to make sure you understand what instructions apply to your personal health. It is important to follow these instructions carefully so your surgery can proceed as scheduled.
• Packing a hospital bag: include items that will help you feel more comfortable, such as loose fitted clothing and any toiletries you may want. Leave all valuables at home, but make sure to bring your health card. Consider bringing a list of personal contacts with phone numbers for you or your health team to contact your loved ones after surgery.