Improving Success of Hip & Knee Replacement Surgery

You can lower your risk of complications after hip replacement or knee replacement surgery with a number of lifestyle strategies, including weight control, avoiding alcohol, and not smoking.

Surgical complications can involve infections, persistent pain, inadequate wound healing, and joint stiffness. When you are planning to have hip or knee replacement surgery, it's important to consider whether you are ready to take the steps that can help prevent complications.


Weight Loss

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Obesity can exacerbate joint pain and can contribute to the need for joint replacement. Obesity also makes knee and joint replacement surgery riskier. 

People who have a body mass index (BMI) of more than 40 are at a higher risk of post-operative infection and have a higher likelihood of requiring revision joint replacement surgery.

If you are overweight, it's important that you focus on losing weight prior to your joint replacement surgery. Exercise can be difficult when you have chronic joint pain, but there are ways to exercise that don't place too much stress on joints. Your healthcare provider or physical therapist can guide you when it comes to safe and pain-free physical activity.


Quit Smoking

quit smoking
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Smoking and tobacco products affect microvascular circulation, which has a direct impact on healing after surgery, including joint replacement surgery.

Smoking increases the chance of developing wound infections, experiencing wound healing problems, and readmission to the hospital after joint replacement surgery.

Quitting smoking prior to surgery can improve the outcome after joint replacement. Most surgeons recommend that you quit smoking for a minimum of six weeks, if not longer, prior to undergoing surgery—and some surgeons are starting to obtain pre-operative nicotine tests to help ensure the best possible surgical outcomes. 


Avoid Alcohol

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While drinking alcohol infrequently or in moderation is unlikely to lead to risks related to joint replacement surgery, drinking frequently or heavily can increase the chances of surgical complications.

If possible, limiting alcohol consumption prior to elective surgery can help prevent complications. And informing your healthcare team about the amount of alcohol you consume is equally important.

Many people underestimate the amount of alcohol they consume. If you are unsure of how much you drink, keep a daily log by writing down how many drinks you consume each day for a few weeks. Give this information to your healthcare provider to help them manage your care when you undergo surgery.

Prolonged hospitalization is the most common surgical complication that affects people who consume heavy alcohol.


Manage Blood Glucose

If you have diabetes, surgery can affect your blood sugar. There are many aspects of surgery that can affect blood glucose. The requirement to fast from food and drink before surgery, not eating during and after surgery, and having less physical activity may impact your appetite. All of these changes can mean that your diabetes medication dose will need adjustment for a few days or longer.

Additionally, diabetes often decreases blood flow in small blood vessels and affects the immune system—these factors can impair wound healing and infection risk. Having good blood glucose control in the weeks leading up to your surgery can help reduce the impact of these factors.


Treatment for Anemia



Anemia is a condition in which you have a low red blood cell (RCB) count or impaired RBC function. RBCs are oxygen-carrying cells, and a deficiency can cause problems related to surgical healing. Anemia also increases the likelihood that you may need a blood transfusion after having a joint replacement.

Causes of anemia include:

  • Iron deficiency
  • Kidney dysfunction
  • Inflammatory conditions

Most often, postoperative anemia can be prevented with treatment prior to surgery.

The treatment for different types of anemia varies. Iron deficiency anemia is often managed with nutritional supplements, whereas other types of anemia may require medications or interventions.


Maintain Mental Health

older woman worried
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Mental health plays a significant role in the likelihood of a successful outcome after joint replacement surgery. People who have clinical depression are more prone to experiencing severe post-operative pain, developing surgical complications, are less satisfied with the results of the surgery, and have a higher chance of needing revision joint replacement.

It is important to identify clinical depression prior to undergoing joint replacement surgery.

If you are diagnosed with depression, you can get treatment from a mental health professional prior to undergoing surgery so you can optimize the results of your joint replacement surgery.

A Word From Verywell

The decision about whether you should have joint replacement surgery requires careful consideration. The outcomes of this type of surgery tend to be very good. However, complications can occur, and avoiding these complications should be one of your top priorities. Following these steps will help you gain some control of your risk of complications.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Tompkins G, Neighorn C, Li HF, Fleming K, Lorish T, Duwelius P, Sypher K. Extremes of body mass index have significant impact on complications, readmissions, and utilization of post-acute services after primary total hip arthroplasty. Bone Joint J. 2020 Jul;102-B(7_Supple_B):62-70. doi:10.1302/0301-620X.102B7.BJJ-2019-1527.R1

  2. Haynes MS, Alder KD, Bellamkonda K, Kuzomunhu L, Grauer JN. Incidence, predictors, and timing of post-operative stroke following elective total hip arthroplasty and total knee arthroplasty. PLoS One. 2020 Sep 17;15(9):e0239239. doi:10.1371/journal.pone.0239239

  3. Negus OJ, Watts D, Loveday DT. Diabetes: a major risk factor in trauma and orthopaedic surgery. Br J Hosp Med (Lond). 2021 Jan 2;82(1):1-5. doi:10.12968/hmed.2020.0609

  4. Richards JE, Kauffmann RM, Zuckerman SL, Obremskey WT, May AK. Relationship of hyperglycemia and surgical-site infection in orthopaedic surgery. J Bone Joint Surg Am. 2012 Jul 3;94(13):1181-6. doi:10.2106/JBJS.K.00193

Additional Reading

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.