Nutrition therapy after surgery is very important as it promotes wound healing and enhances the nutritional status for patients with surgical wounds, ensuring they receive adequate nutrients. This is especially important for patients undergoing joint replacement surgery, where the body utilizes compounds from food to repair tissues and energize cells for the natural wound healing process, reduce infection risk, and alleviate fatigue. Therefore, food plays a significant role in helping patients recover and return to normalcy more quickly. Moreover, weight control post-surgery is crucial to reduce stress on the freshly operated knee joint, preventing excess weight bearing, reducing pain, and facilitating a successful recovery.

Typically, after joint replacement surgery, patients will stay in the recovery room for 1-2 hours. Once awoken from anesthesia, they will be moved back to their room. Initially, they may receive blood transfusions, saline, and post-surgery antibiotics. Patients might experience nausea and still feel under the weather, hence the need for saline until they can eat sufficiently on their own and then continue to recover in the hospital, usually for about 5-7 days.

Risks and Side Effects After Surgery

• Fatigue from surgery due to blood and fluid loss in the body
• Nausea and vomiting after surgery due to medication effects
• Loss of appetite or inadequate food intake for the body’s needs, especially in elderly patients
• Chronic diseases, such as poorly controlled diabetes, may slow wound healing
• Patients who are overweight or obese may exert more force on the knee joint
• Constipation

Nutrition After Joint Replacement Surgery

Guidelines for choosing food for patients after joint replacement surgery include:

1. Nutrition to Promote Wound Healing

1.1 Protein plays a role in the body by building and repairing tissues. A lack of protein can slow the tissue-building process in a body with wounds or surgical incisions, increasing protein needs beyond normal levels. Important protein sources include amino acids from foods such as lean meats, eggs, milk, cheese, yogurt, peanuts, legumes, etc.

1.2 Carbohydrates and fats help supplement energy to cells. They also improve white blood cell function, reduce infections, and speed up wound healing. Sugars are essential for providing energy to the body and are necessary for white blood cell aggregation. Fats store energy, form cell walls, and a lack of carbohydrates and fats leads to protein breakdown for energy use. Carbohydrate sources from food include rice, bread, biscuits, grains, taro, potatoes, starch, etc. Fat sources from food include animal fat such as fish, yogurt, ice cream, cheese, milk, etc., and plant fats such as olive oil, rice bran oil, soybean oil, avocado, almonds, walnuts, etc.

1.3 Minerals include sodium, potassium, chloride, calcium, and phosphorus. These elements maintain cell function and balance the water level consistent with cells. The balance of salts and water is crucial for maintaining blood circulation in tissues. If the skin is dehydrated, nutrients cannot nourish cells effectively.

1.4 Zinc is a mineral important for tissue cell creation. When there is a wound from surgery, the body’s need for zinc increases. Zinc sources from foods include oysters, mussels, sunflower seeds, liver, red meat, fish, eggs, etc.

1.5 Vitamins are essential for the wound healing process, help synthesize collagen, and combat infections, such as
– Vitamin C from foods like oranges, grapes, lemons, strawberries, cantaloupes, etc.
– Vitamin E from foods like vegetables, rice bran oil, etc.
– Vitamin A from foods like liver, carrots, orange fruits and vegetables, green leafy vegetables, etc.

2. Nutrition to Help Reduce and Control Weight to an Appropriate Level

Good weight loss does not necessarily reach standard or normal weight. Current evidence suggests that losing just 5 – 10% of current body weight can help reduce health problems and stress on the knees  Choosing the right food and making appropriate changes are key factors in weight loss, with the following guidelines:

2.1 Reduce energy (calories) from normal diet by 500 – 1,000 calories per day, which can lead to losing about 0.5 – 1.0 kg per week. Eat all food groups for complete nutrients, consult a doctor or dietitian for the appropriate amount of consumption.

2.2 Eat all meals, but reduce the amount of food at each meal, such as reducing rice by 1 – 2 tablespoons per meal, eat more vegetables to get dietary fiber and feel full longer, decide the amount of rice in one go and don’t add more. Skipping meals not only increases food intake for the next meal but also reduces metabolism (energy usage), leading to weight gain if eating the same amount while using less energy.

2.3 Eat meals on time and meals should not be too far apart. Letting meals become too distant often leads to eating more than usual and may limit the selection of appropriate foods.

2.4 Do not skip breakfast, as it will lead to eating more in the next meal.

2.5 Choose to eat low energy / low-fat foods more often, such as egg whites, tofu, fish, lean meat, and green leafy vegetables. Avoid high-fat foods like fatty meat, processed foods, sausages, bacon, fried foods, coconut milk dishes, bakeries, margarine, mayonnaise, gravy, salad dressings, etc., because 1 gram of fat gives 9 kilocalories of energy, which is twice the energy from carbohydrates or proteins.

2.6 Choose to eat boiled, steamed, grilled, baked, salad food instead of fried food, limit the amount of oil used in cooking and use oil not exceeding 1 teaspoon per meal.

2.7 Drink low-fat or fat-free milk or yogurt instead of full-fat dairy products, as they are high in fat and cholesterol, avoid sweetened condensed milk and all flavored milks.

2.8 Avoid eating sweets, snacks, candies, honey, sweet drinks, and soda.

2.9 Avoid alcoholic beverages, as alcohol provides almost as many calories as fat.

2.10 Eat slowly, chew food thoroughly, to help eat less.

2.11 Reduce / avoid adding fish sauce, salt, soy sauce, or salty seasonings before eating.

2.12 Use artificial sweeteners or sweetening agents instead of sugar to substitute sugar in food / drinks.

2.13 If feeling hungry between meals, choose foods high in dietary fiber, such as fresh/boiled vegetables, lean meat without skin or fat, or non-sugar drinks.

2.14 Avoid nibbling on high-energy food/snacks, as frequent consumption like this can result in unnecessary excess energy intake.

2.15 Choose to eat fresh fruit in appropriate amounts instead of canned fruit, sweets, and avoid drinking fruit juice.

3. Nutrition for Patients with Fatigue, Nausea, Vomiting, Little Appetite

Patients after surgery may experience fatigue, tiredness, sleeping on and off, wound pain, or nausea, dizziness, and vomiting due to blood loss, body fluid loss, and the effects of anesthesia. During this time, doctors will allow patients to rest fully, thus they may have a lack of appetite and eat less than the body needs. Therefore, food is highly important in helping patients recover and return to normalcy more quickly.

For eating after surgery, start with soft, low-fat, mildly flavored easy-to-digest food. Important foods include proteins to help build and repair damaged tissues and speed up wound healing. All types of meat can be prepared for post-operative patients, just ensure they are soft and tender. For instance, fish, tofu, eggs are good as they are easy to digest, not chewy, and suitable for patients. For vegetables, choose ones with soft stems, cook leaves until soft and tender. Fruits should be soft without hard peel or too many fibers, like ripe bananas, ripe papayas, ripe mangoes, etc. For sweets, choose ones with mild sweetness and soft texture, such as Thai custard, ice cream, gelatin, custard, wet sago, etc. Suitable drinks include milk beverages, soy milk which are calcium sources, or fresh fruit juices. Avoid tea, coffee, but if necessary, choose the type without caffeine. Alcoholic beverages should be avoided.

Soft food provides energy and nutrients sufficient for the needs of patients if they can eat them entirely. Therefore, caring for post-operative patients is about making them eat. The taste of food is still crucial; even mild flavors, if balanced, can be highly palatable, similar to strongly flavored food. The way food is served, its appearance can stimulate the desire to eat, helping forget the pains of illness somewhat. In case of loss of appetite, eating small amounts more frequently, about 5 – 6 meals, can help increase energy intake.

When patients can eat better, switch to higher energy food. If the patient still has a lack of appetite, eats little, not enough for the body’s needs, consider giving nutritional supplements or medical food with complete nutritional and nutritional value to ensure patients receive enough energy and nutrients.

4. Nutrition for Diabetic Patients to Help Control Blood Sugar to an Appropriate Level After Surgery

4.1 Eat a diverse and complete set of food groups, which are rice/pasta/grains, vegetables, fruits, meat/legumes, milk, and fats, to receive a complete range of nutrients.

4.2 Choose high fiber foods, such as brown rice, unpolished grains, vegetables, and fruits.

4.3 Eat food in the amount that dietary specialists recommend, consuming each food group in nearly the same amount every day.

4.4 Eat meals spaced about 4 – 5 hours apart.

4.5 Do not skip any meals.

4.6 Eat food around the same time every day.

4.7 Avoid high-fat and high-sugar foods.

4.8 Avoid sweets, snacks, and sugar-added beverages.

4.9 Manage weight to stay within an adequate range. For those who are overweight, losing about 5 – 10% (approx. 3 – 10 kg) from the original weight can significantly improve blood sugar control.
 

5. Nutrition for Patients with Constipation Conditions

Constipation refers to a frequency of bowel movements less than normal. In a healthy person, the frequency of bowel movements is once a day or three times a week. Therefore, defecating less than three times a week is considered abnormal. Proper food intake, adequate meals, and sufficient water intake help the digestive system and excretory system function normally, especially food with adequate fiber from vegetables, fruits, grains, and different seeds, which human stomach and intestinal enzymes cannot digest, will be expelled with stool. The benefits of dietary fiber help stimulate the intestines to contract better, making stools larger and softer, easier to pass. The required amount of fiber is at least about 25 – 30 grams per day. Consuming more than 50 – 60 grams of fiber per day may cause bloating, gas, or interfere with the absorption of some vitamins and minerals.

Sources of dietary fiber include:

• Various vegetables such as cooked amaranth, cooked kale, water celery, Chinese cabbage, should consume at least 1 – 2 tablespoons per meal
• Fruits such as bananas, ripe papayas, guavas, mangoes, apples, should eat whole fruits per meal, about 8 – 10 small pieces
• Whole grains such as brown rice, red rice, black sesame, corn
• Dried legumes such as cooked red beans, cooked mung beans, black beans, pumpkin seeds, sunflower seeds
• Other sources include water-soluble fiber types, inulin found in onions, garlic, cabbage, asparagus