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My 82-year-old father is hale and hearty and insists on getting a knee replacement despite his age. The surgeon is willing but says Dad must see a dentist first and get some help with personal hygiene. What does this have to do with knee surgery? Is it just a way for the surgeon to put Dad off a bit longer and hope he'll change his mind?

More and more older adults are being proactive in asking for treatment they feel will improve their quality of life. Joint pain is definitely one of those things that can be very limiting. Pain and loss of motion decrease function and keep folks from being more active. The recommendations made by your father's surgeon may have more to do with preventing infection and ensuring a successful outcome than trying to delay surgery intentionally. Studies show that the condition of the teeth and gums before surgery can have an impact on the rate of infectious bacteria that can enter the body and then travel to the joint and cause destruction. In the same way, dry skin and infrequent washing can increase the risk of cracks, sores, and other ways for bacteria to get past the body's first line of defense. The effect can be the same: joint infection that results in implant failure. A simple program of improved personal hygiene can be very effective in reducing the risk of post-operative infection. And with older adults, immune system failure is also more likely. So, as the old saying goes, An ounce of prevention is worth a pound of cure. Encourage your father to take the surgeon's advice. If he is in doubt as to the reason for these steps, just have him call the surgeon's office. The nursing staff is probably very tuned in to the need for patient education. They can explain to you and to your father the reasons for these recommendations.

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