Our goal is to return you to your normal activities and reduce your pain while “doing no harm.” Every interaction with a medical provider has its risks and benefits and we want more benefits than risks. Thus, when you decide on an orthopedic surgical procedure, we will review the common risks associated with this procedure so you clearly understand the potential risks. Although some complications cannot be anticipated and avoided, there are some areas where both the surgeon and the patient can work together to help significantly reduce these risks. Here is a partial list of some of the most common:
Although the hospital, the surgeon, or the surgical team try to eliminate your risks for infections, they can not eliminate all bacteria and risks. However, your role as a patient is critical to reducing this risk. Here are a few areas where a patient can help reduce this risk:
Inform your surgeon or his staff of any previous surgical infections. If you have had a post-surgical infection in the past, you are at a higher risk for another infection. It is important to inform your surgeon of this infection including the type of bacteria and the eventual appropriate antibiotic used to treat this infection. Your surgeon can instruct you in a protocol to use prior to the surgery to reduce, but not totally eliminate, the number of bacteria on your body just prior to your surgery.
If you have an ongoing infection at a time within a few weeks of your surgery, please inform your surgeon and seek medical treatment. If you have an infected tooth or gum disease, you should make a dental appointment as soon as possible to treat this infection. If you have cuts, scrapes, or rashes over the surgical site, these contain millions of harmful bacteria and they need to be completely resolved prior to your surgery. Urinary tract infections or infections of your toes or hands (not including toe nail fungus) need to be reported and treated by your primary care physician or specialists prior to the start of your elective surgery.
Do NOT Shave over the surgical site
Using a razor over the surgical site produces microscopic cuts and scrapes which fill immediately with millions and billions of bacteria. One of the worst actions you can do prior to a surgery is to shave your legs or arms. The surgical team loves to see hairy legs and armpits. This means there is a lower chance of infections. So go "European" for a week and save yourself the chance of an infection.
Showering with Antibacterial Soap
Using an antibacterial soap a few days prior to your surgery can help reduce the number of bacteria on your skin. We recommend the same surgical soap we use to wash our hands. We have this available in our office. If you forget to purchase this soap, you can use over the counter antibacterial soap such as Dial ™. Normally, we ask that you gently wash your body from head to toe first with your normal soap and shampoo. Do not scrub or scrape the surgical area. Turn off the shower and gently apply the soap all around your body avoiding your hair, face and genital areas. Gently lather for 5 minutes than wash this off and towel dry. Do not apply moisturizers or powders to the surgical site area.
Discontinuation of Disease Modifying Agents
Certain drugs used to treat auto-immune diseases such as rheumatoid arthritis or psoriatic arthritis can interfere with the body’s natural immune system and increase the rates of infection. Medications such as infliximab, etanercept, leflunomide and adalimumab should be stopped approximately between 2 to 6 weeks prior to your surgery. You should discuss this with the doctor prescribing the medications.
Increases in your blood sugar can lead to higher rates of infections. Keeping your blood sugars stable and below the 200 mg/L rate can help reduce these risks. Careful monitoring of your blood sugars for a few months prior and immediately after your surgery can reduce your risks. You should discuss this with your treating physician and even consider a referral to a nutritionist.
Patients with a body mass index (BMI) greater than 40 have a greater rate of postoperative infections. You can estimate your BMI by clicking onto: nhlbi.nih.gov
Patients with lower albumin (a specific protein found in your blood) levels have a higher risk of infection. Patients with very poor nutritional status such as patients with anorexia or undergoing chemotherapy may have very low albumin levels and they should postpone surgery until they meet with a nutritionist and correct these deficiencies.
This is a condition where you form a clot within the veins of your legs or arms and this can cause swelling and sometimes pain. These clots can also move and eventually travel into your lung causing what is known as a pulmonary embolism. With any orthopedic surgery, your risk for a blood clot increases. Some orthopedic procedures have a higher risk such as knee and hip replacement, while others have lower risks, such as carpal tunnel or shoulder surgery. However, this is still a complication you should be made aware of and you can also take steps yourself to help reduce this risk. Here are a few common ways to reduce your risks:
Past History of Blood Clots
If you have had a history of blood clots and were treated for this condition with medications such as Coumadin, please inform your surgical team. A past history of a blood clot places you at a higher risk for another clot in the future. We can take extra precautions to help reduce this risk.
Family History of Blood Clotting Disorders
If you know of first-degree relatives such as your mother, father, sisters or brothers who have had a few blood clots in the past, this may indicate that there may be a clotting disorder in your family. If they have had numerous blood clots in their legs or lungs and they have been tested for an inherited disorder such as Leiden V, please inform your surgeon.
Medications Causing Blood Clots
Some medications such as birth control pills, hormone replacement and some cancer fighting medications can increase your risk for blood clots and you should have a discussion with your prescribing physician about holding or discontinuing these blood clot causing medications at least 2 weeks prior to your procedure.
Excessive Swelling of the Legs or Arms
Some patients have excessive swelling of their extremities which are not related to the swelling of their joints. Conditions such as edema from heart failure should be reduced by simple measures such as elevation, and the use of compression stockings as much as possible prior to your surgery. The addition of simple ankle pumping exercises seen below will also help.
Perform Calf Exercises After Surgery
Simple ankle pump exercises and calf stretching exercises can help mobilize excessive fluid and stagnant blood in your legs to reduce the chance of a blood clot. The video explaining these is listed in the previous section. These should be done at least 10 times every hour while awake until you are able to walk normally. Here is a link to a video explaining how to perform these exercises: https://youtu.be/GyDEvpxduNc
Elevate your Extremity
After surgery, it is very normal for the extremity to swell. Gravity is a great way to reduce this swelling since all fluids tend to move to seek the lowest force of gravity. This means your legs have to be higher than your heart. It is normally recommended that your legs have to at least 10 cm with the hip bent no more than 45 degrees and the knee bent at 20 degrees. This can be accomplished with the use of a large couch cushion and a smaller bed pillow. Place the larger couch cushion on your bed followed by a standard pillow from your bed on top of the cushion. You should elevate your leg at least twice a day while awake. And during most of the night for the first 2 weeks after surgery. Some patients require more, but this is a bare minimum.
Some other complications such as bruising and wound healing can also be reduced by some actions on your part. Excessive bleeding and bruising can be caused by medications of supplements that cause the blood become thin. Some of these include anti-inflammatory medications such as Motrin or Aleve. Supplements such as vitamin E and lecithin can also lead to hire rates of bruising. Poor nutrition with lower levels of blood proteins can lead to poor healing of wounds and tissues. Having a thorough evaluation by your family or primary care physician with certain laboratory testing can help identify these deficiencies.The purpose of this conversation is to help our patients understand some of the common complications after surgery and what steps you can take to modify and reduce these risks.