As the global population ages, degenerative arthritis has become a major health challenge for many elderly individuals. When the knee or hip joint experiences severe wear, stiffness, and persistent pain that do not respond to conservative treatment, joint replacement surgery is often the path to regaining mobility. However, for elderly patients who also suffer from chronic diseases such as diabetes or heart disease, the physiological stress imposed by this type of major orthopaedic surgery is considerable. In recent years, the highly precise robotic-arm assisted joint replacement surgery has brought new hope to patients. Before preparing for this advanced surgery, a comprehensive and rigorous pre-operative risk assessment is absolutely critical to ensure surgical safety and good post-operative recovery.
The Potential Impact of Old Age and Chronic Diseases on Joint Replacement Surgery Before deciding on joint replacement surgery, the medical team’s primary consideration is not simply the degree of joint wear, but the patient’s overall physiological tolerance. Elderly patients often have multiple chronic conditions, which directly affect anaesthesia risk and the quality of post-operative wound healing.
Blood Glucose Control and Infection Risk in Diabetic Patients Medical research clearly indicates that in diabetic patients with poor blood glucose control, the rates of wound inflammation, superficial or deep tissue infection, and even acute kidney injury after joint replacement surgery are significantly higher. One of the key pre-operative indicators is HbA1c (glycated haemoglobin). If HbA1c exceeds 8%, the risk of post-operative complications increases markedly. Therefore, in the three months before surgery, patients must work closely with their endocrinologist and orthopaedic surgeon to adjust blood glucose to an optimal range through diet, exercise, and medication. This effectively reduces the risk of prosthetic infection and delayed wound healing.
Management of Heart Disease and Cardiovascular Risk Total joint replacement places a certain physiological burden on the cardiovascular system. For patients with hypertension, coronary artery disease, or a history of stroke, a detailed cardiac function assessment must be performed before surgery. In addition, many heart disease patients regularly take anticoagulants (blood thinners) or aspirin. The medical team needs to precisely determine when to stop and resume these medications to prevent excessive bleeding during surgery or venous thromboembolism after surgery.
What Constitutes a Comprehensive “Pre-operative Risk Assessment”? To ensure surgical safety for elderly patients and those with chronic diseases, the orthopaedic surgeon will work with an anaesthesiologist and an internal medicine physician to conduct a multidisciplinary, comprehensive pre-operative risk assessment. This not only tailors the anaesthesia plan to the individual patient but also minimises potential risks. Below are common pre-operative assessment items:
To confirm absence of severe anaemia or inflammation, ensure adequate liver and kidney function for anaesthetic drug metabolism, and verify that blood glucose is under control.
Imaging Studies
Standing X-rays, electrocardiogram (ECG), chest X-ray or CT scan if needed
To accurately measure joint deformity angles and bone quality; ECG is used to screen for potential arrhythmias or ischaemic heart disease.
Anaesthesia & Cardiopulmonary Assessment
Anaesthesiologist consultation, assessment of daily exercise tolerance
To decide between general anaesthesia or regional (spinal) anaesthesia based on the patient’s heart disease and blood pressure status, and to determine safe anaesthetic dosages.
Dental and Skin Examination
Oral examination, check for unhealed wounds or fungal infections on the body
To prevent potential sources of infection. Bacteria from the oral cavity can travel through the bloodstream to the artificial joint and cause severe late prosthetic joint infection.
Medication Reconciliation
Review of all current prescription drugs, Chinese herbs, and supplements
To identify medications that must be stopped before surgery (e.g., biologics for rheumatoid arthritis, certain antihypertensives, or blood thinners) and avoid drug interactions.
Robotic-Arm Assisted Joint Replacement: How Precision Medicine Improves Safety for High-Risk Patients Traditional joint replacement surgery relies heavily on the surgeon’s visual judgment and clinical experience. However, for elderly patients with poor bone quality or those with chronic diseases who require minimizing surgical time and trauma, robotic-arm assisted joint replacement technology represents a revolutionary breakthrough.
The robotic arm system allows the surgeon to input the patient’s joint images into a computer before surgery, creating a 3D model that assists in precisely planning the bone cuts and the placement angle of the artificial joint. During the procedure, the robotic arm is equipped with a high-resolution tracking system, keeping the margin of error well within 1 mm or 1°.
This sub-millimetre precision offers three major advantages:
Preserves more healthy bone and soft tissue: Reduces unnecessary trauma, especially beneficial for elderly patients with lower physiological reserves.
Reduces intraoperative blood loss: For heart disease patients, less blood loss means smaller blood pressure fluctuations and a lower cardiovascular burden.
Accelerates post-operative recovery: Reduced tissue damage leads to significantly less post-operative pain. Many patients can even get out of bed on the day of surgery, greatly lowering the risks of deep vein thrombosis and pneumonia associated with prolonged bed rest.
Risk Assessment – Peace of Mind and Confidence “Advanced age” and “chronic disease” should never be reasons to give up on quality of life. As long as a rigorous pre-operative risk assessment is performed, and with the aid of advanced robotic-arm assisted joint replacement technology, even elderly individuals with diabetes or heart disease can safely undergo surgery and take steady steps once again.
Union Hospital has an experienced multidisciplinary medical team equipped with state-of-the-art technology. We are committed to providing comprehensive pre-operative assessments and personalized treatment plans for every patient suffering from joint degeneration, ensuring your surgical safety at every step. If you or your family member is troubled by joint pain, please contact Union Hospital to schedule an orthopaedic consultation. Let our professional team help you regain a flexible and active life.
Frequently Asked Questions (FAQ)
What HbA1c level should diabetic patients achieve before undergoing joint replacement surgery? General medical recommendations advise that diabetic patients should keep their HbA1c as low as possible, ideally below 7% to 8%. If the level is too high, the surgeon will likely recommend postponing elective joint replacement surgery and work with an endocrinologist to adjust blood glucose, thereby reducing the risk of post-operative infection and poor wound healing.
If I have heart disease and am taking blood thinners, do I need to stop them before surgery? Usually, yes. Blood thinners (anticoagulants) increase the risk of surgical bleeding. Based on your specific condition, the orthopaedic and cardiology teams will arrange for you to stop the medication several days to one week before surgery, or briefly switch to a short-acting injectable anticoagulant. Do not stop any medication on your own – always follow your doctor’s instructions.
How long is the recovery period after robotic-arm assisted joint replacement surgery? Thanks to the high precision and minimally invasive nature of robotic arm surgery, soft tissue damage is minimized. Most patients can get out of bed with a walker under the guidance of a physical therapist on the day of surgery or the day after. The typical hospital stay is a few days to one week, and most basic daily activities can be resumed after about 4 to 6 weeks.
Can a patient over 80 years old tolerate general anaesthesia? The purpose of a pre-operative risk assessment is precisely to safeguard elderly patients. The anaesthesiologist will evaluate the patient’s cardiopulmonary function to assess anaesthesia risk. In fact, many lower limb joint replacement surgeries can be performed using spinal anaesthesia (regional anaesthesia) combined with sedation, which has a relatively smaller impact on the respiratory and cardiovascular systems and greatly improves anaesthesia safety for elderly patients.
Why is a dental examination necessary before orthopaedic surgery? An artificial joint is a foreign implant. If a patient has severe periodontal disease, tooth decay, or untreated rotten teeth, bacteria from the oral cavity can easily enter the bloodstream during tooth brushing or chewing, then travel to and adhere to the artificial joint, causing a deep infection that is very difficult to treat. Therefore, addressing potential sources of infection before surgery is critically important.
