Tips on Preparing for RA Surgery
Surgery for rheumatoid arthritis (RA) is generally only considered when the joint damage has become so severe that it is impacting a person’s ability to move and causing a significant decline in their quality of life. Medications cannot fix joint damage or deformities caused by RA, but surgery may be able to restore function or help minimize the impact of RA on the joint.
If surgery is your next step, there are some practical things that you can do to help your surgery go more smoothly and to give your recovery a better chance at being successful.
Get your body ready for surgery
Surgery can have a major impact on your body, and it’s important to be in the best physical shape you can to help your body prepare for this period of healing. Your pre-surgery plan should involve exercise, healthy eating, and controlling any existing health problems you may have.
Depending on which joints are affected by RA, exercise may be challenging, but it’s important to stay as active as possible before your surgery. Regular exercise looks different for everyone, but staying active and taking time to include exercise on most days is a good place to start. Regular activity is especially important if you are going to have major joint replacement surgery. Results from studies have shown that a program of exercise before major joint replacement surgery can decrease pain and speed up recovery after surgery.1,2
Talk to your doctor about working with a physical therapist (PT) in the months leading up to your surgery. A PT can work with you on a targeted program of strength and flexibility training specifically designed to get you ready for surgery and prepare you for a program of rehabilitation after surgery.
Healthy eating and nutrition
In addition to getting the exercise you need, you should make sure that you are eating well and getting proper nutrition. You can do this by following USDA nutritional recommendations for a healthy, balanced diet, or consult with a nutritionist or registered dietician. Also talk to your doctor about what supplements, including vitamins and minerals, might benefit you. It is especially important that you let your doctor know about any and all medications, vitamins, mineral, herbs, and other supplements, that you are taking. Some of these may need to be stopped well before surgery if they increase your risk for bleeding or have other effects that make them dangerous to take around the time of your surgery.
Other important health issues
As you prepare for surgery, you should make sure that you are taking care of any health conditions you may have, including hypertension, cardiovascular disease, and diabetes. Work with your doctor to get the treatment you need for these and other chronic health conditions. Also, as you prepare for surgery, if you are a smoker, you should take the opportunity to stop smoking. Smoking can delay wound and bone healing, makes it more difficult for the body to fight off infections, and may increase the pain felt after surgery.3 Ask your doctor for help with smoking cessation, as there are many programs and medications that may help you quit.
If you are overweight, make it a goal to lose weight before your surgery. This is especially important if you are having major joint replacement surgery. Carrying around extra weight places increased stress on joints and can make it more difficult to rehabilitate after surgery. Extra weight can also decrease your chances for a successful surgical outcome, may shorten the life of a surgical repair, and increase the risk of blood clots and infection.4 In terms of general health, losing extra weight can have many benefits, including reducing your risk for cardiovascular events and improving control of chronic conditions like diabetes. Use a program of regular exercise and healthy eating to help you achieve a healthy weight before you undergo surgery.
Create a recovery plan with your doctor
Prior to surgery, sit down with your doctor to put together a plan for your recovery. You will want to make as detailed a plan as possible, complete with recovery milestones and strategies for dealing with complications, if they arise.
Having a plan on paper will help you to set goals during rehabilitation and know what to expect from week to week. For instance, if you are having total major joint replacement surgery, your rehab may include home visits and/or an outpatient rehab program. Having physical goals written down on paper will help organize and motivate you. The success of a major surgical repair, such as joint replacement, greatly depends on following your rehabilitation program.
Put together a care plan for after surgery
Planning for surgery doesn’t just cover your selection of a surgeon and preparation in the months and weeks leading up to surgery, it must also cover the days, weeks, and months after your surgical procedure. This post-surgery period, especially rehabilitation, follow-up, and after care, are, in a sense, just as important as the procedure itself.
Practical planning. There are some basic arrangements that you and your caregivers (friends and family) will need to attend to before you undergo surgery. The list will vary from person to person and will be different depending on the extent of your surgery, but it should cover items including:
- A plan for getting to and from the hospital or surgical clinic
- Having someone to take care of basic chores (meal preparation, shopping, house cleaning, walking pets, personal care activities) during the period when your mobility and function is restricted
- Transportation to and from doctor’s appointments and rehabilitation sessions
Taking care of practical aspects of life will be easier if you have family living with you, but if you live alone, you will need to recruit your friends and family to volunteer for specific activities or care shifts. While it may be difficult to ask, people who care about you want to help, and there are some handy online systems available for coordinating care among a circle of friends and family during a period of recuperation from illness or surgery. Check out Lotsa Helping Hands and Care Calendar.
Insurance coverage and other financial matters
Insurance coverage is complex and can be stressful in the best of times. To ease your recovery period, Make sure that you take care of this important bit of planning before you have surgery. Different insurance plans have different requirements in terms of out-of-pocket expenses and you will want a clear picture of how much of the cost of care (both surgery and rehabilitation) you will have to cover.
Call your insurance representative and find out what arrangements you need to make for the financial aspects of both surgery and rehabilitation. Depending on your coverage, you may discover that you qualify for more services than you think. It makes sense to take advantage of whatever benefits you qualify for under your insurance.
If you are covered by Medicare and have questions about what services are covered under Medicare, you can get an answer by calling 1-800-MEDICARE (1-800-633-4227).
If you are employed, speak with your human resources representative and find out how best to plan your surgery from the standpoint of your work schedule.
- Start or continue your exercise program
- Eat nutritious food before and after surgery
- Lose weight if needed
- Stop smoking (ask your doctor about smoking cessation products)
- Make sure that existing medical conditions are under control
- Make a recovery plan with your doctor to include milestones and strategies for dealing with complications, if they arise
- Arrange transportation to and from the hospital
- Set up a support system of friends and family who can take care of household chores and other practical aspects of life while you are recovering
- Make sure that you have volunteers lined up to get you to and from appointments
- Make all your insurance arrangements before you have surgery so there are no surprises during your recovery period
- Find out what out-of-pocket expenses you will be responsible and what services (including rehabilitation and nursing care) are covered
- Topp R, Swank AM, Quesada PM, Nyland J, Malkani A. The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty. Pm R 2009;1:729-35.
- Swank AM, Kachelman JB, Bibeau W, et al. Prehabilitation before total knee arthroplasty increases strength and function in older adults with severe osteoarthritis. J Strength Cond Res 2011;25:318-25.
- How Smoking Affects Healing. American Orthopaedic Foot & Ankle Society. Available at http://www.aofas.org/footcaremd/how-to/foot-health/Pages/How-Smoking-Affects-Healing.aspx. Accessed 5/31/18.
- Weight Loss Before Joint Replacement Surgery. University of Michigan. Available at http://www.med.umich.edu/1libr/Surgery/OrthoSurgery/JointReplacementObesity.pdf. Accessed 5/31/18.