Our knowledge of orthopaedics. Your best health.

Diabetes Mellitus and Orthopaedic Surgery

If you are pre-diabetic or diabetic, talk to your doctor about the best way to get your blood sugar under control and your heart, lung, kidney, and liver function as healthy as possible before surgery.

Uncontrolled diabetes can:

• Slow the healing of bones, muscles, tendons, and/or skin
• Increase your risk of infection

Be sure to tell your surgeon if you are taking insulin, GLP-1 medications, or blood sugar stabilizers.

• Surgery can cause increased stress to your body and higher blood sugar, so your insulin dose may need to be adjusted.
• Your surgeon should also know if you take oral or injectable medications for diabetes. Some of these should be discontinued before you are given anesthesia, as they may interfere with anesthesia medications or slow digestion and leave food in your stomach longer.

Anemia and Orthopaedic Surgery

Anemia (low red blood cell count) increases your risk of cardiac and wound complications during surgery. Before surgery, your red blood cell count should be checked. If it is low, your doctor will work with you to increase it before surgery.

In addition, discuss with your surgeon the plans for managing any blood loss that may occur after surgery.

Opioid/Narcotic Drug Use and Orthopaedic Surgery

If you regularly use opioid or narcotic medication to control pain, it can make it harder to control pain after orthopaedic surgery. Chronic opioid or narcotic use before surgery can lead to complications, including pneumonia, and withdrawal problems like seizures and confusion.

Talk to your doctor about how to decrease or stop your opioid medication before surgery. Consulting a pain specialist may be necessary to help optimize your opioid use and avoid triggering addiction.

Be sure to discuss all of your opioid and narcotic medications with your orthopaedic surgeon and primary care physician so that they can determine an appropriate plan for managing your pain both before and after surgery.

Varicose Veins, Leg Swelling, and Blood Clots and Orthopaedic Surgery

Orthopaedic surgery and postoperative immobility (lack of movement) can increase the risk of blood clots forming in your legs. Blood clots can cause pain and swelling and may even travel to other parts of your body, such as your lungs. Learn more: Deep Vein Thrombosis

Be sure your surgeon knows if you or a family member has a history of blood clots, or problems with varicose veins or leg swelling. For some operations, blood thinners or compression devices for your legs are used to help prevent blood clots.

Learn more: Preventing Blood Clots After Orthopaedic Surgery (Video)

High Blood Pressure/Hypertension and Orthopaedic Surgery

If you have high blood pressure, talk to your surgeon and primary care physician about your medications.

In the days before your surgery, check your blood pressure several times. It should be well-controlled with medication by the day of surgery. If it is not controlled, your surgery could be delayed.

Smoking and Orthopaedic Surgery

Smokers have a greater risk of serious complications after orthopaedic surgery than nonsmokers. These complications include wound infections, pneumonia, heart attack, and stroke.

Smoking can also slow down or prevent broken bones from healing, and it can delay the bone healing needed for successful joint replacement and spinal fusion surgeries.

To improve your chances of a successful surgical outcome, it is recommended that you:

• Stop smoking for at least 1 month before surgery
• Try not to resume for several weeks afterward — or, better yet, not at all

Learn more: Orthopaedic Surgery and Smoking

Obesity and Orthopaedic Surgery

Overweight and obese patients are at increased risk of medical and surgical complications, including wound infections, pneumonia, blood clots, and heart attack.

Talk to your surgeon or primary care physician about losing weight before surgery. Weight loss can lower your risk of complications and possibly even decrease the need for orthopaedic care by reducing the amount of stress on your joints.

Diet and Nutrition Before Orthopaedic Surgery

A healthy diet with proper nutrition is important for your recovery. Both before and after orthopaedic surgery, you should follow a balanced diet that includes adequate protein and vitamins.

Your orthopaedic surgeon or primary care physician may recommend blood tests to check your nutritional health. Improving your nutritional health can decrease your risk of wound infection and slow healing after surgery.

Physical Conditioning and Orthopaedic Surgery

Sleep Apnea and Orthopaedic Surgery

Sleep apnea is a medical condition that causes irregular breathing when you are sleeping. People who are older or have a higher BMI are more likely to have this condition. Undiagnosed sleep apnea increases your risk of cardiac complications during recovery from your surgery.

If you suspect you have sleep apnea, ask your primary care or family physician and orthopaedic surgeon about preoperative testing and treatment for the condition.

Depression and Orthopaedic Surgery

A history of depression or low energy that requires medical treatment can result in an increased dependence on opioid pain medication after surgery and a slower recovery.

If you have symptoms of depression before surgery, seek treatment so that you are physically and mentally prepared for your procedure and recovery.

Memory Impairments and Movement Disorders and Orthopaedic Surgery

Memory loss and movement disorders, such as Parkinson's disease, may put patients at a greater risk of post-operative falls or confusion.

Having a friend or family member stay with you during your hospitalization and recovery can help you stay mentally clear and more comfortable with your healthcare team and hospital environment. Family and friends can also help you navigate your surroundings and support you to prevent falls.

Tell your surgeon about all the medications you may be taking for your movement disorder because some may reduce your need for post-operative pain medication.

Surgical Site Skin Preparation and Orthopaedic Surgery

Clean and healthy skin is vital for proper wound healing.

• Avoid shaving the skin in the area of your planned incision for 2 weeks before surgery.
• On the day of surgery, wash the area with an over-the-counter chlorhexidine soap several times. This soap can also be used when you return home after surgery to help keep your hands clean and protect your incision while it heals.