Dr. Kimberly M. Sanders, ND
As an autoimmune arthritis specialist, I come across patients undergoing joint replacements on a weekly basis. Naturopathic adjunct therapies can be used to reduce complications and poor outcomes after this type of surgery. Many of these same complementary approaches can be tried early in the arthritic process to attempt to reduce the need for joint replacement surgery in the future.
Multiple studies have noted the association between poor outcomes after joint replacement and elevated BMI. One study in over 1,500 patients evaluated how BMI affected patients 3 years after knee replacement. The study found that gaining weight after the surgery was associated with increased pain in these people.1 Another common complication after joint replacement is infection and blood clots. Studies have shown, when looking at over 20,000 knee replacements, that obesity is significantly associated with more infections and venous blood clots after surgery than in patients who are not obese.2 Also, patients with morbid obesity are at higher risk for needing a reoperation in the future.3 Patients who plan to undergo a joint replacement should consult with a naturopathic physician, nutritionist, and/or personal trainer for a diet and exercise plan. Losing weight in a healthy way before surgery may help prevent some of these complications. If you have recently undergone joint replacement surgery, losing weight may help prevent the need for future joint replacements.
A 2014 study evaluated the effect of psychological stress before surgery on outcomes after the joint replacement. The study found that patients who were stressed before the surgery were doing poorly 1 year after knee replacement when compared to those people who were not stressed before surgery. 4 Another study found that depression is associated with worsened pain and functioning after knee replacement.5 Patients who are feeling stress or emotional distress, including anxiety and depression, should seek counseling or naturopathic care before joint replacement to improve the chances of better success after surgery.
One of the most important lifestyle changes that can improve a patient’s success after joint replacement is to quit smoking. A 2014 study compared the outcomes after hip replacement in smokers versus nonsmokers. Smokers had lower survival than nonsmokers, and smokers had other complications that nonsmokers did not have, including pneumonia, infections, and nerve damage.6 A 2012 also found that smokers who had knee replacement surgery had less survival and more complications from the surgery.7
Acupuncture is one of the modalities that can be considered for reducing stress and emotional distress prior to joint replacement surgery. A study of 120 patients showed that therapeutic acupuncture improves anxiety, depression, and quality of life after 6 months in patients with psychological distress.8 In addition to the positive effects on stress management, anxiety, and depression, acupuncture may also be useful for patients who would like to quit smoking before joint replacement surgery. A number of trials have concluded that acupuncture performed specifically in the ear improved smoking cessation rates within three months.9
Vitamin D is one of the most common vitamin deficiencies in patients undergoing hip replacement. Some studies have found that as many as 65% of patients undergoing hip replacement had a deficient vitamin D level.10 Vitamin D deficiency is linked to poor outcomes after hip replacement surgery.11 In addition, having low vitamin D levels also puts a person at risk for bone fractures around the new hip joint after surgery.12 Vitamin D is also a very important nutrient for the immune system. It is no surprise that patients undergoing joint replacement surgery who also had low vitamin D were at an increased risk of infection around the new joint.13
Vitamin D may have additional roles in the recovery period after surgery. Vitamin D may affect muscle strength and the risk of falling after surgery. One study found that patients who supplemented vitamin D after surgery had improved muscle strength.14 This improved muscle strength improves overall balance and strength in older adults. Vitamin D supplementation, therefore, should be considered in patients undergoing joint replacement surgery. Patients should ask their doctor for a vitamin D test before surgery in order to determine the right vitamin D dose.
Preparing for joint replacement surgery can help prevent complications or the need for reoperation. Some of the complications of joint replacement include infection, blood clot, pain, and bone fracture. Naturopathic therapies may help prevent some of these complications, according to the research. Weight loss may be an appropriate goal if you are currently obese. Discuss weight loss strategies and an exercise plan with your doctor. Losing weight may help your surgery be more successful and prevent complications. If you are experiencing a high level of stress, anxiety, or depression, or if you are struggling with smoking, then acupuncture may help manage these. Each of these has been linked to worse outcomes after joint replacement. Vitamin D deficiency is also very common in those who need joint replacement, so you should ask your doctor for a vitamin D test before surgery. Improving your vitamin D level may improve your balance and muscle strength, and it may also help prevent infections after surgery.
Kimberly M. Sanders, ND, is a licensed naturopathic physician in Connecticut. She graduated from the University of Bridgeport and completed her CNME-accredited residency training there, as well. She was named 3-time MVP of the ZRT Cup Competition as a medical student. Dr Sanders currently owns ArthroWell Naturopathic, a specialty practice in rheumatology. She has undergone extensive pediatric and rheumatology training, and has lectured on the topic of autoimmunity and autism at the annual CNPA and NHAND conferences. Her passion in practice is finding the underlying cause of immune dysfunction and restoring balance to the immune system with functional medicine.
- Mackie A, Muthumayandi K, Shirley M, Deehan D, Gerrand C. Association between body mass index change and outcome in the first year after total knee arthroplasty. J Arthroplasty. 2015;30(2):206-9.
- Si HB, Zeng Y, Shen B, et al. The influence of body mass index on the outcomes of primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2015;23(6):1824-32.
- Watts CD, Wagner ER, Houdek MT, et al. Morbid obesity: a significant risk factor for failure of two-stage revision total knee arthroplasty for infection. J Bone Joint Surg Am. 2014;96(18):e154.
- Utrillas-compaired A, De la torre-escuredo BJ, Tebar-martínez AJ, Asúnsolo-del barco Á. Does preoperative psychologic distress influence pain, function, and quality of life after TKA?. Clin Orthop Relat Res. 2014;472(8):2457-65.
- Lopez-olivo MA, Landon GC, Siff SJ, et al. Psychosocial determinants of outcomes in knee replacement. Ann Rheum Dis. 2011;70(10):1775-81.
- Kapadia BH, Issa K, Pivec R, Bonutti PM, Mont MA. Tobacco use may be associated with increased revision and complication rates following total hip arthroplasty. J Arthroplasty. 2014;29(4):777-80.
- Kapadia BH, Johnson AJ, Naziri Q, Mont MA, Delanois RE, Bonutti PM. Increased revision rates after total knee arthroplasty in patients who smoke. J Arthroplasty. 2012;27(9):1690-1695.e1.
- Arvidsdotter T, Marklund B, Taft C. Six-month effects of integrative treatment, therapeutic acupuncture and conventional treatment in alleviating psychological distress in primary care patients–follow up from an open, pragmatic randomized controlled trial. BMC Complement Altern Med. 2014;14:210.
- Di YM, May BH, Zhang AL, Zhou IW, Worsnop C, Xue CC. A meta-analysis of ear-acupuncture, ear-acupressure and auriculotherapy for cigarette smoking cessation. Drug Alcohol Depend. 2014;142:14-23.
- Lavernia CJ, Villa JM, Iacobelli DA, Rossi MD. Vitamin D insufficiency in patients with THA: prevalence and effects on outcome. Clin Orthop Relat Res. 2014;472(2):681-6 11)
- Nawabi DH, Chin KF, Keen RW, Haddad FS. Vitamin D deficiency in patients with osteoarthritis undergoing total hip replacement: a cause for concern?. J Bone Joint Surg Br. 2010;92(4):496-9.
- Unnanuntana A, Rebolledo BJ, Gladnick BP, et al. Does vitamin D status affect the attainment of in-hospital functional milestones after total hip arthroplasty?. J Arthroplasty. 2012;27(3):482-9.
- Maier GS, Horas K, Seeger JB, Roth KE, Kurth AA, Maus U. Is there an association between periprosthetic joint infection and low vitamin D levels?. Int Orthop. 2014;38(7):1499-504.
- Diamond T, Wong YK, Golombick T. Effect of oral cholecalciferol 2,000 versus 5,000 IU on serum vitamin D, PTH, bone and muscle strength in patients with vitamin D deficiency. Osteoporos Int. 2013;24(3):1101-5.