4 Crucial Ways to Prevent Joint Replacement Failure and Avoid Re-Surgery

According to the Highlights of the 2023 American Joint Replacement Registry Annual Report by Ryan et al. (2024) over the Last 10 Years, 2.58% of Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) Procedures Resulted in Re-Surgery.

A study conducted by Weber et al. (2018) re-surgeries cost 76% more than primary replacement procedures, and most patients report increased pain and discomfort following re-surgery. In addition to improving the quality of orthopaedic implants to increase their longevity, patients can take proactive steps to reduce the likelihood of re-surgery.

4 Crucial Ways to Prevent Joint Replacement Failure and Avoid Re-Surgery

1. Maintain a Healthy Weight

Weight is one of the key reasons that can hinder the longevity of orthopedic implants. Obesity in adults is reaching epidemic proportions, with an increase of 11% in adults classified as overweight or obese [3]. Obese patients are likely to receive THA 10 years younger than their counterparts with normal BMI [4].

Several studies reported that BMI has no effect on the implants [5],[6],  but obese patients have displayed a lower range of movement and limited satisfaction [7]. A study by Traina and Brodini further noted that the rate of revision surgery was higher for patients above 80 kg [8]. Excess body weight places additional stress on implants, particularly in weight-bearing joints like hips and knees. The increased load on implants leads to increased wear. Wearing of implants results in their degradation and, thus, warrants a re-surgery [9]. Maintaining a healthy weight, therefore, reduces the risk of implant loosening, wear, or failure. Patients who undergo THA or TKA should attempt to maintain a healthy weight to increase their implant life. This can indicate exercises should be performed that are recommended and approved by their healthcare provider. Other measures may include but are not limited to dietary changes i.e., avoiding sugar, sodas, snacks, etc.

2. Maintain Bone Health

The strength of the bone that needs to grow to anchor the implant in place is another necessary factor that the patients should focus on for the implant to have an increased life. Patients need to consume a diet that is rich in calcium and vitamin D since both play a crucial role in enhancing bone strength. Maier et al., in their study published in Annals of Translational Medicine, 2021,   reported a significant increase in implant life reducing re-surgery risk when calcium and vitamin D were administered. Vitamin D plays a crucial role in bone growth, and it has been associated with ensuring the right balance between bone resorption and bone formation; both of which are pertinent for the growth and sustenance of new bone [10]. This indicates that the diet of the patients should be rich in vitamin D or they should consume vitamin D supplements. It is particularly crucial for patients who have received THA or TKA for diseases such as osteoporosis or osteosarcoma since its deficiency is linked to decreased density of bone. Similarly, calcium is one of the main components of the bone. It is associated with a reduction in phenomena that may weaken the bone while promoting bone formation [11].

So, the diet that is taken post-surgery should also be calcium-rich or contain supplements of calcium along with vitamin D. This will lead to better strength of the bone to anchor on the implant. Better integration leads to a lesser risk of revision surgery. Thus, integrating calcium and vitamin D is a great wayof ensuring the longevity of orthopedic implants.

3. Prevent Infections

Infections can jeopardize implants by causing inflammation or loosening. Infections in implant areas result in devastating outcomes and can be classified according to the route and onset of symptoms after implantation. Several strategies have been studied to enhance antibacterial function of the implants yet there still is room for improvement. The factors that can increase the risk of developing infection include diabetes, rheumatoid arthritis, psoriasis, obesity, etc [12]. The patients, especially the ones with the aforementioned conditions, need to practice good hygiene and care for their wounds to avoid infections. Patients should maintain an adequate level of moisture in their wounds. They should clean their wounds as advised by their healthcare providers. Wound dressings should also be changed regularly to avoid the accumulation of bacteria. They should also inform healthcare providers about their implants before any surgical or dental procedure to receive prophylactic antibiotics if recommended. It is also important to watch for signs of infection (e.g., swelling, redness, or warmth around the implant site) and seek prompt medical attention.

4. Stop Smoking

Most people understand the impact of smoking in terms of lung diseases, heart diseases, or mouth diseases. What they may not know is that smoking is considered an independent risk factor in surgical site infections. It has also been linked with increased postoperative complications.

Smoking can cause inflammation and impair the immune system, leading to delayed healing. This may lead to pneumonia, postoperative pneumonia, wound infection, invasive pneumococcal disease, and the increased fatality of bacteremia. Other conditions that may be attributed to delayed healing are a higher risk of infection due to bacteria forming biofilm on the implant and subsequent loosening [13]. Consequently, smokers are at an increased risk of receiving re-surgery than non-smokers. Therefore, patients need to work towards overcoming their addiction/habit after orthopedic surgeries in order to ensure the longevity of orthopedic implants. Quitting smoking improves overall health and supports better outcomes for implant longevity.

Conclusively, if the patients maintain a healthy weight, maintain their bone health, look for signs of infection, and avoid smoking, they may be able to contribute to the longevity of their implants. This would help them avoid the revision surgery and lead to superior outcomes postoperatively.

Key Takeaways

• Maintain a healthy weight through dietary changes and approved/ recommended physical activity such as exercise.
• Consume calcium and vitamin D-rich diet through natural sources or supplements.
• Ensure hygiene of the wound after surgery and carefully examine it through the healing process for any abnormality.
• Avoid smoking.