The risk factors that are more likely to contribute to an unsatisfactory result from joint replacement surgery include, but are not limited to, the following:
Severe heart disease may preclude any major surgery. Clearance by a heart doctor is essential if there is any suspicion of heart disease
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
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; follow-through with rehabilitation will be difficult
Chronic use of narcotics and other strong painkillers before surgery means that these drugs will not work after surgery. If you have developed a dependence on such medications, do not have joint replacement surgery unless this problem is addressed first.
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, seizures, or alcohol-related medical problems such as liver disease, will complicate the results of any joint replacement procedure. Social or moderate alcohol use of course is a different story; it is not a contraindication to successful joint replacement surgery.
Patients who desire surgery because of pending litigation, unresolved workers’ compensation issues, or any other reason besides severe pain from proven degenerative joint disease generally end up with a disappointing result.
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
Patients who have had a stroke or have Parkinson’s disease, 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.
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.
If you are already in a wheelchair or bedridden, it is nearly impossible to get them walking again simply with a successful joint replacement procedure
If 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
Please be aware that in general, young and muscular patients are most likely to have the following outcomes after joint replacement 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 at best a synthetic 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
People who do not take care of themselves will likely do poorly and can 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; 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 can lead to 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.
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.
Hostility, anger, passive-aggressive, and antisocial 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.
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.