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Patients who are good candidates for this surgery have already failed the conservative measures including physical therapy, anti-inflammatory medicines, as well as injection treatments. Typically we use steroids or a type of viscosupplementation, which is a gel like substance that improves the viscosity of the fluid. Typically these are used in knees to delay knee replacement surgery. There are other forms of injection treatments available such as PRP and stem cell. Unfortunately, these have not yet been cleared by the FDA and do require substantial cost. Once many of these have already been completed and the pain persists, the patient is then a candidate for joint replacement surgery. There are particular subgroup of patients who are very high risk for joint replacement surgery. In our institution. We have cutoff values for different conditions such as diabetes with an A1C value of greater than 7.0%. another high risk population are patients who are obese. A BMI greater than 40 is a contraindication for joint replacement surgery due to the high risk of infection that these patients pursue. Typically patients with a higher than BMI of 40 require aquatic physical therapy, an appointment with a nutritionist to decrease and assist with their nutrition and BMI, as well as physical therapy. Typically in three to four months, we can get many of these patients much more reasonable down into a level which is much safer to proceed with joint replacement surgery. The last subgroup of patients who are very high risk are active smokers. We have multiple studies showing that smokers have a much higher risk of infection related and wound complications following their surgery, and we do require abstaining from smoking for at least three weeks prior to their joint replacement surgery and certainly during their recovery.

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