Risks of Orthopaedic Surgery and How to Minimize Them

Common Risks in Orthopaedic Surgery

• Infection: Patients with a history of diabetes or malnutrition face a higher risk.
• Blood clot: This occurs when there are intimal rips or plaque fractures.
• Nerve Damage: The risk level depends on the difficulty of the surgery and the area of surgery.

Factors Influencing Surgical Risks

• Patient Health: Patients with chronic conditions such as diabetes, hypertension, heart disease, or respiratory issues are at a higher risk. Other health issues such as malnutrition weakens the immune system, and obesity complicates anaesthesia and wound healing.
• Age: Elderly patients may have reduced physiological reserves and slower wound healing.
• Type of Surgery: Complex surgeries have higher risks. Emergency surgeries also generally carry higher risks than elective, pre-planned procedures

Pre-Surgical Assessments to Identify Risks

Pre-surgical assessments are essential for identifying and minimising potential risks, ensuring patient safety during surgery.

• Physical Examination: A physical examination that assesses the patient's current health status, including cardiovascular and respiratory function, and neurological assessments.
• Laboratory Tests: Blood tests are often done to blood glucose and electrolyte levels, which helps to identify any problems.
• Imaging studies (X-rays, CT scans, or MRIs): This aims to check for any existing conditions that might affect the surgery, like unusual structures or tumours.
• Cardiac Evaluation: For surgeries that might affect the cardiovascular system, an electrocardiogram (ECG or EKG) may be performed to assess heart function.
• Medication Review: The orthopaedic surgeon is required to check all the medications a patient is taking, including prescriptions, over-the-counter drugs, and herbal supplements to find any possible interactions and make changes to the medications if necessary.

Strategies to Minimise Risks Before Surgery

Making lifestyle changes and exercising before surgery can reduce risks for patients is one way to reduce risks. This includes advising smokers to quit. For people who are overweight, losing weight through diet and exercise helps lower risks such as blood clots and breathing problems. Proper nutrition supports the immune system and healing after surgery. Pre-surgery exercises strengthen muscles and help patients get in better shape for recovery. Relaxation techniques like mindfulness can also help manage anxiety and prepare patients mentally.

Patients with pre-existing health conditions may require specific medications or treatments to stabilise their conditions before undergoing orthopaedic surgery. Examples include:

• Hypertension: Controlled with medications such as ACE inhibitors or beta-blockers to reduce blood pressure.
• Cardiovascular disease: Controlled with medications such as aspirin or clopidogrel to prevent blood clots and reduce the risk of heart attacks or strokes during and after surgery.

Intraoperative Techniques to Reduce Risks

Advanced surgical techniques and technologies are available for orthopaedic surgeries. Minimally Invasive Surgery (MIS) is a technique that employs small incisions and specialised instruments, resulting in less tissue damage, less bleeding, and faster recovery. Computer-Assisted Surgery (CAS) utilises computer guidance systems to ensure implants are placed accurately.

Post-Surgical Care to Mitigate Complications

Post-surgical care is crucial for preventing complications such as infections, blood clots, wound rupture, and delayed healing. Following instructions regarding wound care, activity restrictions, medication management, rest, nutrition and hydration reduces the risk of adverse outcomes and supports the recovery process.

Rehabilitation and physical therapy are important for a speedy recovery as it can improve strength and flexibility, reducing muscle weakness and joint stiffness through early mobilisation. The sessions focus on improving strength, range of motion, balance, and walking. Managing pain effectively allows patients to participate in therapy and continue making progress. Gradually increasing activity level prevents overexertion and reduces reinjury risk.

Patient Education and Informed Consent

Patient education is important as it helps the patient understand the risks and benefits of their treatment, allowing them to engage in discussions with their healthcare providers and identify the best course of action. Before surgery, patients will receive explanations from their orthopaedic specialist regarding all aspects of their treatment, including potential risks and positive outcomes.

Patients are encouraged to ask questions and share their concerns. Additionally, patients retain the right to decline treatment at any point. Documenting these discussions and obtaining patient approval demonstrates respect for their autonomy and facilitates collaborative decision-making between patients and healthcare providers.

Understanding and minimising risks is important for successful surgical outcomes; and patients are encouraged to take an active role in their surgical care plan and recovery.