Six Ways to Ensure Joint Surgery Success 

A study published in the  BMJ in 2014 found that patients whose surgeons perform more than 35 total hip replacements (THR) per year – roughly three or more per month – have fewer complications compared to patients whose surgeons don’t meet that threshold. And the fewer replacements they do, the higher the rate of complications. Experience in years did not matter, the study found; the difference comes with repeatedly performing the surgery. Your primary care doctor can recommend an experienced surgeon.

The same goes for the hospital you choose: Studies have found that complication rates after total joint replacement generally are lower in those with a higher volume of surgeries. One 2016 study from the National Institutes of Health found that when it comes to total hip replacements, hospitals that do more than 400 surgeries a year have significantly fewer complications (and are less expensive) than those with lower volume. More than 80% of people in the U.S. live within 50 miles of a high-volume hospital, and many now opt for a very high-volume hospital – one that does more than 1,000 joint replacements a year. 

Doctors worldwide stopped using metal-on-metal (MoM) hip implants after they were found to have high failure rates and to cause other complications. But metal is still a component in some implants and, though rare, some people have allergies to the metals used. Chromium, nickel, cobalt, titanium and molybdenum are among the most common metals found in implants. Symptoms may include pain or loss of function in the implant area, weakness or fatigue, diarrhea and headaches. Testing before joint replacement surgery isn’t recommended for everyone, and most available tests aren’t considered accurate. Still, if you’ve had a reaction to metal in the past – to jewelry, for example – you may want to talk to your doctor about a test.

Smokers have significantly higher rates of complications than non-smokers do, including blood clots, abnormal heartbeat, urinary tract infection and kidney failure. One study found that the overall revision rate – meaning the number of surgeries that had to be redone – was 10 times higher for smokers compared with nonsmokers: 10% vs. 1%. But quitting isn’t easy and usually takes time. To get started: 

• Choose a quit date, then plan how you’ll go about it. 

• Find ways to stay active, manage stress and prevent weight gain during and after you quit. 

• Talk to your doctor about nicotine replacements and other medicines that may make quitting easier, and ask friends and family for support.

Hip and knee implants are designed to bear normal weight – a body mass index (BMI) of 18 to 25. Many studies, including a 2018 meta-analysis in BMJ Open, have found the surgery may be less effective and cause more complications when people weigh more. Obese patients (BMI of 30 or higher) are more likely to have long-term pain and disability and problems such as blood clots and implant dislocation. Many surgeons recommend losing weight both before and after joint replacement, and most won’t operate on patients with a BMI of 40 or higher. There’s no sure-fire way to lose pounds and keep them off. But a diet high in vegetables, healthy fats and moderate amounts of fish or chicken along with daily exercise is a good place to start. If you have a lot to lose or can’t go it alone, talk to your doctor about medically supervised weight loss. 

Having chronic conditions like diabetes and heart disease make complications during and after joint replacement more likely. People with diabetes may be twice as likely to get an infection after surgery, for example, and those with liver disease are readmitted to the hospital significantly more often. Most chronic illnesses can’t be cured, but you and your doctor should work together to ensure you’re as healthy as possible before having surgery.