The majority of orthopedic surgeries are considered “elective” because they are not being performed for life-threatening or limb-threatening problems. They are pre-planned and done on a non-emergent basis. These surgeries might be considered simple or low risk (like a knee arthroscopy or carpal tunnel surgery), or more major and higher risk (like joint replacement or spinal fusion). In general, you need to meet some health parameters in order to be considered a good candidate for elective surgery, especially if it is a major surgery. If you don’t meet those parameters, your surgeon might require you to postpone your surgery until you are “healthy enough” to proceed with surgery. This is not a punishment, but rather it is out of concern for you as a patient, as your surgeon wants you to have the best possible outcome from your procedure, with the lowest possible risk of complication. It is important to understand that there is no such thing as a “risk-free” surgery, no matter how minor the procedure is.
Some of the more common parameters considered when determining if a patient is healthy enough for a major surgery include, but are not limited to: blood pressure, lab values, body mass index, blood sugar/HgA1c, heart health, and lung function/smoking. If any of these parameters don’t meet criteria, surgery might need to be postponed until the problem is addressed. If the problem can’t be improved, then surgery might not be an option. Here is a list of some of the health problems, and a few of their respective associated risks, that need to be corrected before undergoing elective orthopedic surgery:
- Blood pressure greater than 180/110 mmHg (120/80 is normal): higher risk of heart attack or stroke during or soon after surgery.
- White blood cell count greater than 11,000/microliter (4,500-11,000 is normal): could indicate an infection somewhere, increasing risk for surgical infection.
- Hemoglobin less than 10 g/dL (normal for men is 13.2-16.6 and for women is 11.5-15): increased risk of needing blood transfusions, wound healing problems, and increased risk of death post operatively.
- Electrolytes such as potassium or sodium too high or too low (normal for potassium is 3.6-5.2 mmol/L and normal for sodium is 135-145 mEq/L): abnormal heart rhythms, muscle cramps, fatigue, or confusion.
- Albumin level less than 3.4 g/dL (3.4-5.4 is normal): significant risk for wound healing problems, prolonged hospitalization, and even death.
- Body Mass Index greater than 40 (18.5-24.9 is normal): significant increased risk of blood clots, infection, blood loss, and anesthetic complications, as well as increased risk of in-hospital death.
- Blood sugar greater than 200 mg/dL (90-110 is normal) or HgA1c greater than 8.0% (normal is below 5.7): significant increased risk for infection and wound healing problems.
- Heart disease: increased risk for stroke, heart attack, and death during or after surgery.
- Lung disease and/or being a smoker: risk for anesthesia complications, cardiovascular events (stroke, heart attack, etc.), delayed wound healing, wound infections, pneumonia, delayed bone healing, and death.
Your individual surgeon will have their own parameters that might slightly differ from those listed. This list is not complete, but reflects some of the more common health issues that need to be optimized prior to having elective orthopedic surgery. Anesthesiologists also have their own parameters that have to be met, though they are similar to those listed here. You don’t have to be perfectly healthy to have orthopedic surgery, but you do need to be “healthy enough.” Remember that your surgeon has your best interests at heart, and wants you to have a complication-free surgery and a full recovery. While they can’t eliminate all risks related to surgery, optimizing your health goes a long way to lowering your risk of complications.
Tulsa Bone & Joint Sand Springs is pleased to welcome Christopher Crane, MD. Dr. Crane is a sports medicine fellowship-trained physician.
Dr. Crane is a native of Broken Arrow and graduated from Broken Arrow High School. After completing his undergraduate degree at The University of Tulsa and medical training at The University of Oklahoma College of Medicine, Dr. Crane completed his residency at The University of Texas at Tyler. Dr. Crane then went on to complete a fellowship in Sports Medicine from The University of Oklahoma.
Tulsa Bone & Joint is pleased to welcome Dr. Crane to our practice. He will lead our clinic in Sand Springs and provide nonsurgical orthopedic treatments, such as ultrasound-guided injections, fracture care, and treatment of sports and workers’ compensation injuries. Tulsa Bone & Joint Sand Springs also offers physical therapy and on-site X-rays. We are thrilled that Dr. Crane has chosen to join our growing practice of musculoskeletal physicians.
Tulsa Bone & Joint Sand Springs is located in the Springs Village Shopping Center in Prattville at 3917 OK 97.
Dr. Christopher Crane: Moving Life Forward for Sand Springs
By Caleb Nunley, MD
We are fortunate in the Tulsa area to have The Gathering Place and multiple other fun parks. Unfortunately, though, in orthopedics, we see multiple playground injuries. I thought it might be helpful to share some tips on playground safety in hopes of avoiding and preventing some of the most common injuries.
Below are some tips and general guidelines:
1) The child should always wear shoes to avoid splinters and cuts.
2) Sunscreen and plenty of water are important on hot summer days.
3) Make sure the playground has a soft surface underneath the equipment. This needs to extend several feet away from the equipment. This could be rubber, mulch, sand or other materials. The most common emergency room visit from a playground injury is from a fall. Also, check to ensure that the playground is well maintained. Equipment that is poorly maintained may have sharp edges, be unstable or rusty. If the playground equipment is wet, it increases the risk of slipping and falling, and if the equipment is hot, it is a risk for burns.
4) Make sure that the child is playing on developmentally appropriate equipment and utilizes the equipment appropriately.
- Monkey Bars: the child should be using for climbing and not acrobatic stunts.
- Swings: should not be used for jumping off of. Also, make sure children are aware when walking in front of swings.
- Slides: the child should never climb up the front of the slide. (As a parent of a two year old myself, I know this one is especially tough). The child should sit down on their bottom facing forward as they go down and should move away from the bottom of the slide as soon as they reach the ground. An important note is that toddlers should not go down the slide on a parent’s lap. This has been shown repeatedly to be a risk for leg fractures. Fractures/breaks can happen in multiple ways, including when the toddler’s leg is caught underneath the parent, when the child’s leg is caught on the side of the slide, and when the force of the parent accompanying them down breaks the leg.
5) Supervision is likely the most important factor in preventing injuries. This includes providing children guidance on the proper use of equipment, as well as monitoring and adhering to playground safety rules.
We hope you don’t need us, but if there is an orthopedic injury, please give us a call at 918-392-1400! Most importantly, have fun! Stay safe and happy playing!
If you have an orthopedic injury or disease that requires surgery, your overall health is a factor that helps determine how well you will recover from that injury or surgery. Certain health problems can negatively affect your outcome, including peripheral vascular disease, diabetes, osteoporosis, and obesity. Most of these health issues can improve with treatment. Since many orthopedic surgeries are non-emergent, I recommend that these health problems be addressed prior to any elective orthopedic surgery.
One of the most common health issues associated with orthopedic problems is obesity. Obesity is a medical diagnosis, and is defined as having a Body Mass Index (BMI) > 30.0. BMI is calculated as follows:
Obesity is frequently subdivided into categories:
- Class 1: BMI of 30 to < 35
- Class 2: BMI of 35 to < 40
- Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as “extreme” or “severe” obesity.
Not only can obesity contribute to the development of degenerative arthritis and other orthopedic problems, it can also lead to significant complications during or after orthopedic surgery, such as joint replacement surgery. Complications could include anesthesia-related events, such as trouble establishing an IV or maintaining an open airway, or requiring large doses of medication to achieve adequate anesthesia. Surgical complications might include longer operative times, increased blood loss, surgical infection, blood clots in the legs that can travel to the lungs, and wound healing problems. These complications can be life or limb threatening, so decreasing the risk of having such a complication is of paramount importance.
If you are considering an orthopedic procedure such as joint replacement surgery, and you carry a diagnosis of obesity, your doctor might recommend or require weight loss prior to your procedure, especially if you have Class 3 obesity. Your doctor realizes that weight loss is not easy, but they also want to “first do no harm.” Your doctor wants to prevent complications as much as possible and ensure that you have a successful recovery. While it might be frustrating to have your surgery postponed until you are healthy enough, it is in your best interests to lower your risk of having a bad outcome by losing weight prior to your procedure.
Obesity is a multi-factorial disease, so there is no single right (or easy) way to lose weight. Some patients think that exercise is the key to losing weight, but there is a lot of truth to the saying, “You can’t out-exercise a bad diet.” Many people with orthopedic conditions have difficulty exercising anyway. If you are able to exercise, it’s best to do low-impact exercises such as using an elliptical machine, stationary bike, indoor rower, or doing water exercises. While exercise will help you burn calories, it is rarely effective as a weight loss method if not combined with dietary changes.
So, weight loss depends mostly on your diet. The best way to start losing weight is to make changes in your diet that can be sustained over a long period of time. Sometimes, it’s just a matter of eliminating sugary drinks like soda, or high calorie substances like alcohol or candy.
Some people have good results with specific diets like the Ketogenic Diet, Paleo Diet, Weight Watcher’s, or Jenny Craig. Others see success with physician-monitored weight loss or consulting a dietitian. Still others might require bariatric surgery if they are severely obese and have failed other methods. Perhaps the ”simplest” weight loss method is to keep a food log and count calories. There are several phone apps that can make this an easier task, such as MyNetDiary or MyFitnessPal. The key is to find something that you can live with over the “long haul” and that fits into your lifestyle. Rapid weight loss is not advisable, as it can result in loss of muscle mass or malnutrition, and the resulting weight loss is harder to maintain. A reasonable goal would be to lose 1-2 points a week. If you accomplish this, you will lose anywhere from 25 to 50 pounds in 6 months!
Patients who need orthopedic surgery, especially joint replacement surgery, often say they will lose weight after their surgery. However, studies show that very few patients with obesity are successful in losing weight after joint replacement.
Therefore, I advise you to establish a healthier lifestyle now, even before you need surgery. Losing weight and reducing your BMI will decrease your risk for complications and increase the likelihood of a successful surgical outcome. It also may decrease your pain to the point where surgery could be postponed or be avoided altogether. If you need help losing weight, discuss it with your primary care physician or surgeon, and they can assist you in finding the help you need.
Have you recently had a hip or knee surgery and are worried about making it through TSA with the new metal plate in your body?
The American Association of Hip and Knee Surgeons has created an excellent video that shows you the one thing you need to know to make it through security.