Knee Replacement Surgery for Diabetic, Hypertensive, Cardiac, and Renal dysfunction patients
Comorbidity is a medical term used to describe a condition that coexists with a patient. Therefore, if you have knee osteoarthritis and suffer from high blood sugar and high blood pressure, Diabetes and Hypertension are co-morbidities.
By learning about comorbidities that can affect knee arthroplasty and how to deal with them, you can make informed decisions about whether knee arthroplasty is right for you.
1. Diabetes
According to the WHO, about 422 million people suffer from diabetes each year and 1.5 million are directly related to diabetes (https://www.who.int). The number of cases is increasing every year, and diabetes will soon become a pandemic.
Unfortunately, many patients with knee osteoarthritis suffer from diabetes as a comorbidity. The majority of diabetes is controlled by oral hypoglycemic drugs (lowering blood sugar levels) or insulin.
Osteoarthritis of the hip and knee causes severe restrictions on movement, making blood sugar control a challenge.
Diabetes has several adverse effects on knee replacement surgery. It delays recovery and causes wound problems.
If diabetes is not controlled, the surgeon will refer you to an endocrinologist. Insulin may be added to the drug before surgery to control blood sugar levels.
2. High Blood Pressure
According to the Lancet (https://www.thelancet.com), the total number of people suffering from high blood pressure (ages 30-79) doubled between 1990 and 2019. Hypertension is another illness whose number has increased significantly.
Hypertension damages the arterial wall for a long period, which delays wound healing in uncontrolled hypertensive patients. High blood pressure also increases the likelihood of cerebrovascular accidents (CVA) or stroke during surgery.
If high blood pressure is poorly controlled, you should see a doctor.
3. Thyroid disease
Thyroid disease can be hypothyroidism (lowering of thyroid hormones T3 and T4) or hyperthyroidism (elevating thyroid hormones). About 5% of the general population suffers from hypothyroidism.
Thyroid disease can affect the effectiveness of anesthesia and recovery from surgery. Selective surgery, such as total knee arthroplasty, should be postponed until normal thyroid function (the normal range of thyroid hormones) is achieved.
4. Cardiac condition
Non-cardiac surgical procedures (like knee replacement) increase the risk of myocardial ischemia, myocardial infarction, and heart block during the peri-operative (during and after) period.
However, elective non-cardiac surgeries are on the rise due to better evaluation and management of cardiac conditions nowadays. You might need a thorough cardiac evaluation like Echocardiogram or Angiogram. A patient suffering from a conduction defect might need temporary pacemaker implantation before surgery.
Please consult your cardiologist for optimization and clearance for replacement surgery.
5. Kidney Dysfunction
When a patient has severe renal (kidney) impairment or end-stage renal disease, joint replacement is not typically recommended. These patients are at much higher risk for complications from surgery and will likely require longer stays in an inpatient rehabilitation setting.
Additionally, their general overall health status tends to be quite poor when compared to other patients undergoing knee replacement, and it may be difficult for them to mobilize following surgery due to their limited strength and energy reserves.
It is also important to note that these patients are at significantly higher risk of urinary tract infections following surgery—one of which could quickly lead to sepsis, kidney failure, and even death.
Joint replacement surgery can be done in presence of mild to moderate kidney disorders that can be managed with medicines or dialysis during the operative period. Consult your nephrologist before replacement surgery.
6. Rheumatoid Arthritis
One of the most common conditions in people with knee osteoarthritis is rheumatoid arthritis. This type of arthritis is caused by an immune system reaction to joints, where a person’s antibodies attack and destroy cartilage and connective tissue within their body.
It can also be more difficult to recover from surgery if you have rheumatoid arthritis, as there may be significant damage and weakness present in other areas of your body.
For example, tendon repair may become problematic after surgery because your immune system attacks these structures as well.
If you are suffering from rheumatoid arthritis, you might be taking several medicines. Visit your rheumatologist, who might modify your medicines during and after surgery.
7. Ankylosing Spondylitis
People with AS have a greater risk of developing osteoporosis and stress fractures than those without. The disease is also characterized by a stiff spine, which can increase the chances of developing arthritis in your joints.
The ankylosed spine can make anesthesia and surgery more difficult and less successful, so if you are suffering from AS, it’s important to talk to your doctor about the risks involved in joint replacement surgery. Sometimes you may need spine deformity correction before lower limb joint replacement surgery.
8. Degenerative Disc Disease
Due to back pain caused by degenerative disc disease, patients may be reluctant to undergo invasive surgery like knee replacement. However, recent studies have shown that there are high levels of success after knee replacement for degenerative disc disease patients.
Researchers recommend a thorough examination before making a knee replacement decision. While some patients might be good candidates for surgery, others might benefit from less invasive methods like physical therapy and pain medications.
There are many comorbid diseases that patients might suffer and elective surgery can be performed after evaluation and optimization. A good pre-anesthesia assessment can predict peri-operative difficulties and correction of uncontrolled diseases can sail you through with manageable risk. The decision to perform or postpone surgery is jointly made by the patient and the doctor.
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