Diabetes and Joint Replacement Surgery 101
If you’re living with diabetes, you know better than anyone that your rulebook for general health is different than most. To add another layer to your health management puzzle, chances are you’ve found this post because you’re a diabetic preparing for a hip replacement or knee replacement or are trying to decide when the right time for a joint replacement is. With this, know that joint replacement surgery is one of the most successful procedures in all of modern medicine and that you have the power to further reduce your risk factors.
What you do in the weeks leading up to your hip replacement or knee replacement will have a huge impact on your surgery results and recovery time. This is especially true for those with pre-existing conditions like diabetes. Taking action before surgery in a results-driven program is called “PreHab”.
Read on as we talk about how diabetes can affect joint replacement surgery, examine surgical complications for those with diabetes, and offer some prehab diet suggestions to optimize your health before due day.
How Can My Diabetes Affect Joint Replacement Surgery?
Diabetes (especially when uncontrolled or paired with a related disease) greatly affects recovery time from joint replacement surgery. Those with diabetes are at a greater risk for infection, slower wound and incision repair, as well as a laundry list of secondary complications.
Uncontrolled Diabetes: Blood sugar levels that are too high (240 and over or consistently outside of optimal zone) is often due to improper diet, lack of exercise, inconsistent medication use and other factors. The risks associated with uncontrolled diabetes include: heart disease, kidney disease, eye damage, neuropathy, amputations, dental issues and more.
Controlled Diabetes: Blood sugar levels maintained in a healthy range (between 75 and 145). In all likelihood medication is taken regularly, diet and exercise are controlled and regular doctor visits are met. The risk of complication (from surgery or from developing a secondary condition) is greatly reduced for someone in control of their diabetes.
As is the nature of diabetes, it is not the diabetes itself that is inherently harmful, but rather the domino effect of health complications that stem from it. For instance, people living with diabetes experience up to 4 times the risk for heart disease, depending on their level of blood sugar control. The more blood sugar fluctuation, the higher the risk for heart disease.
As forward-thinking diabetes expert Cyrus Khambatta explains, heart disease means poor blood flow to brain, heart, finger tips and extremities. This poor blood flow leads to hardened blood vessels. Hardened blood vessels (also known as atherosclerosis) prevent valuable nutrients in the bloodstream from accessing tissues, especially following surgery.
Diabetes, specifically when uncontrolled, can cause a chain reaction of complications that influence one another and snowball into a much larger health problem. A study in the Journal of Bone and Joint Surgery looked at the surgical outcomes of 7567 people with diabetes who've undergone a joint replacement. The study found that 17.5% of patients with diabetes had a related disease or condition (like heart disease, kidney disease etc.). Comparatively, only 2.4% of those without diabetes had a related disease at the time of surgery.
Complications for People with Diabetes Undergoing a Joint Replacement
A 2008 study from Duke Medical University found that patients with diabetes who underwent a hip or knee replacement were at an increased risk for stroke, pneumonia, urinary tract infection, obstruction of the intestine, the need for blood transfusion, as well as other less significant results.
A common thread in the Duke Study, as well as other studies investigating diabetes and joint replacement surgery (like one Journal of Bone and Joint Surgery and another in Clinical Orthopaedics Related Research) is that the obesity that often goes hand-in-hand with type 2 diabetes is a very risky combination before joint replacement surgery.
- The study in the Journal of Bone and Joint Surgery found that “57% of the patients with diabetes who underwent a total knee replacement were obese”.
- The Duke study found that those with uncontrolled type 2 diabetes experienced more complications from joint replacement surgery that any other subgroup.
- The Clinical Orthopaedics study looked at deep infection in 1214 total knee replacement patients and found “no prosthetic infections in patients with diabetes who were not obese but found 11 prosthetic infections in patients who were obese and diabetic.”
Type 2 diabetes is best managed by human controlled factors like diet and exercise. This speaks to how influential you can be in the success of your surgery and diabetes management.
PreHab to Control Your Diabetes and Lower Your Risk
Type 2 diabetes is in part caused by lifestyle factors—such as being overweight, being physically inactive and eating an unhealthy diet—and is best managed through diet and exercise. Type 1 diabetes should also be managed through diet and exercise, but its cause has no proven link to lifestyle.
Regardless of diabetes type, it’s crucial to have a top functioning immune system in order to ward of infection before and after surgery. Another priority is to keep inflammation at bay. It’s becoming increasingly accepted that inflammation is the main cause of diabetic complication. As Dr. Khambatta puts simply, “diabetes is a chronic inflammatory condition and surgery often causes acute inflammation. While the two forms of inflammation are different, eating anti-inflammatory foods can minimize both types of inflammation.” For those with diabetes prehabbing for surgery, Dr. Khambatta and many nutritionists alike recommend eating a diet rich in antioxidants and anti-inflammatory foods from the plant world.
Eat For Your Upcoming Surgery and Beyond
Incorporating foods that are rich in antioxidants and anti-inflammatories into your diet is huge—we will detail a list of powerful pre-surgery foods below (just a minute, kay). What’s even more important is following a strict pre-op meal plan that has been set or approved by your doctor. This meal plan will incorporate the vitamin-rich, nutrient dense superfoods, but will also outline the proper times to eat, right meal sizes to consume, and the best times to take medication in order to grab hold of blood sugar levels.
When managing your blood sugar before surgery, it’s best to eat small meals more frequently.
Your diet is most responsible for your blood sugar levels. If you’re eating for your diabetes, you should see this reflected in a healthy HbA1c level. For those with diabetes, HbA1c will sit above 6% with ideal levels between 6% and 7%. Levels in this range indicate controlled diabetes. If your levels hover above 8% your ability to recover for joint replacement surgery quickly and free of complication is less likely. For this reason, some patients with uncontrolled diabetes are not safe to operate on. Dr. John Tiberi, orthopaedic surgeon explains, “when a patient presents a hba1c over 8%, delaying their operation until they have better control of their sugars is always considered."
A high HbA1c level before surgery is a strong predictor of who will be at risk for high blood sugar on surgery day. Some surgeons will postpone surgery based on a reading of 8% and above.
Foods Rich in Antioxidants and Anti-inflammatories
Before surgery, eat foods that have the highest levels of antioxidants and have the most anti-inflammatory properties.
In your pre-surgery visit, talk to you doctor about anti-inflammatories as they can be pretty powerful. Putting your anti-inflammatory diet on hold in the first weeks following your surgery may be recommended.
These foods will give you pre-surgery superpowers:
- Acai Berries
- Vibrant colored fruits and vegetables (like berries, beets and pineapple)
- Orange colored fruits and vegetables (like squash, mango and sweet potato)
- Spices can have more anti-inflammatory and antioxidant power than food. Top spices are: cloves, turmeric, cocoa powder with no added sugar and cinnamon.
These foods cause inflammation and should be avoided by anyone with diabetes—especially those preparing for a scheduled surgery:
- Refined sugar (white, cane, brown). Don’t forget about sugar in drinks and sauces.
- Refined carbohydrates. Avoid white and starchy foods like white bread, white rice, cereals, crackers, fries, potatoes.
- Gluten/Gliadin (the protein found in wheat). Avoiding gluten products is especially important for those with type 1 diabetes.
- Casein (the protein found in whey and is the protein in dairy). In general, dairy products are pro-inflammatory. This is especially true for those with type 1 diabetes.
- Saturated fats (like cheese).
- Preservatives and trans fats (like polysorbate 80, citric acids, magnesium sulphates etc.). Preservatives and trans fats live in the freezer section foods, in fast food and in many pre-packaged eats.
- MSG. Avoid the additive commonly found in prepared Asian food and soy sauce.
- Aspartame. Say no to fake sugar-free artificial sweeteners.
Exercises to Prepare for a Total Knee Replacement or Total Hip Replacement
A common misconception is that too much exercise will make a joint replacement challenging for the surgeon. This is not true. For all joint replacement candidates, exercise is hugely important when preparing the body for surgery. By performing a few daily exercises leading up to your replacement, you can not only boost your overall health and better control your blood sugar, but can improve your circulation, reduce swelling, and set yourself up for a faster recovery.
Here is a list of 10 PreHab exercises that are low-impact and designed specifically for joint replacement candidates with reduced mobility. In addition, pool prehab, also known as water therapy, is an excellent way to strengthen key muscle groups and perform a level of cardio that may not be too painful on land. Cardio exercise and other targeted exercises can be especially effective for those with diabetes who may have added risk for complication. These at-risk subgroups are those with type 2 diabetes who are overweight, those with diabetes who have a related condition or disease and/or those who have uncontrolled diabetes.
If you take anything away from this article, let it be that although you may not have been dealt the best set of cards, you can still come out on top. Let the knowledge of better eating and proper exercise fuel your joint replacement surgery prehab and beyond. By implementing ongoing lifestyle changes you can be in better touch with your health, drastically reduce your risk of complication, and can start down a path toward better-than-ever health.
Awaiting a scheduled hip or knee replacement? Join PeerWell to PreHab your way to a more successful joint replacement and a faster recovery. Recovery begins before surgery.