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Reasons Your Hip or Knee Surgery Might Be Delayed

Finally, the day has arrived for your joint replacement surgery. You most likely have requested time off from work for the procedure and arranged for a friend or family member to help during your recovery at home. Unfortunately, your procedure might be canceled or delayed on the day of your surgery. I understand this can be frustrating for my patients. It is essential to understand the common reasons why this happens:


  • Illness or Infection prior to surgery: illness like UTI, pneumonia, shingles, flu, or COVID can cause delay.
  • Wound on operative leg prior to surgery: A venous stasis ulcer, lymphedema, cuts, scratches, or abrasions can cause delay.
  • BMI over 40, or inability to meet weight loss goals
  • Elevated A1C: Managing your diabetes is crucial as high blood sugar levels increase your risk for significant post-op complications.
  • Anemia: the typical cutoff range for normal hemoglobin (Hb) concentration is (Hb <10 in women and <11 in men).
  • Poor pre-op nutrition labs (albumin, pre-albumin, transferrin, total lymphocyte count, Vit D levels low)
  • Failed to obtain Cardiac or Specialist clearance
  • Did not stop medications correctly (blood thinners, NSAIDs)
  • Elevated kidney or liver function
  • Alcohol and/or Tobacco consumption: Tobacco use must stop 30 days prior to surgery.

Modifiable risk factors (MRFs) represent patient variables associated with increased complication rates that may be prevented by working with your surgical care team prior to surgery. Modifiable risk factors are behaviors and exposures that can raise or lower a person’s risk for post-surgical complications like periprosthetic joint Infection.

Modifiable risk factors include:

  • MSSA/MRSA colonization
  • rheumatoid arthritis
  • cardiovascular and renal disease
  • diabetes mellitus / hyperglycemia
  • depression/anxiety
  • obesity

Intervention utilizing a multidisciplinary approach for patients with one or more risk factors will be necessary, including patient education, counseling, and follow-up with the doctor. If you are considered a high-risk joint replacement patient, working with your surgical team to address these risk factors can optimize your chances for a successful joint replacement procedure while improving your surgical outcomes. Addressing infections, vitamin levels, nutritional concerns, medications, weight goals, and presurgical skin preparation can profoundly affect your post-surgical healing.

Though some of these reasons for cancellations cannot be predicted or avoided, many of them can. Your surgical team will do everything possible to move forward with your scheduled procedure.

I understand that canceling a patient’s surgery can affect their emotional and physical well-being. Your care team here at Oklahoma Joint Reconstruction Institute will take every possible precaution to avoid such cancellations and help you on your journey to joint health.

Dr. Paul Jacob is a leading hip and knee surgeon in Oklahoma City who pioneered robotic joint replacement surgery in an outpatient setting. Dr. Jacob has performed over 5000 robotic joint replacement procedures and actively participates in numerous research studies on robotic outcomes.

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