Preoperative Patient Optimization Before Hip or Knee Arthroplasty: Part 1
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Published:
Oct 24, 2022
Keywords:
Optimization, joint replacement, hip and knee arthroplasty
Main Article Content
Abstract
Hip and knee arthroplasties are well-known effective strategies for joint osteoarthritis. Joint replacement reliably improves quality of life for most patients when non-operative measures have failed. However, these are major surgeries that carry significant risks, including the need for revision surgery. The purpose of this article is to discuss preoperative modifiable risks parameters of the patient prior to joint replacement to decrease complication risks. Recent studies have described several modifiable factors thatincrease the risk of postoperative complications following hip and knee replacement. These include obesity, malnutrition, tobacco use, diabetes, anaemia, vitamin D deficiency, opioid use, inflammatory arthropathy, kidney chronic insufficiency and meticilinresistant staphylococci colonization. If we achieve preoperative optimization of these conditions, we should minimize the risk ofadverse outcomes.
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Perez Alamino, L., Tillet, F., Bochatey, E., & Lopreite, F. (2022). Preoperative Patient Optimization Before Hip or Knee Arthroplasty: Part 1. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(5), 721-726. https://doi.org/10.15417/issn.1852-7434.2022.87.5.1658
Section
Review article
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References
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2. Fernández-Fernández R, Oñorbe-San Francisco F, Gil-Garay E. Long-term outcomes of a titanium-encased ceramic liner total hip arthroplasty (15 to 21year results). J Arthroplasty 2021;36(11):3697-702.
https://doi.org/10.1016/j.arth.2021.06.016
3. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007;89(4):780-5. https://doi.org/10.2106/JBJS.F.00222
4. Wall C, de Steiger R. Pre-operative optimisation for hip and knee arthroplasty: Minimise risk and maximise
recovery. Aust J Gen Pract 2020;49(11):710714. https://doi.org/10.31128/AJGP-05-20-5436
5. Choi HR, Bedair H. Mortality following revision total knee arthroplasty: a matched cohort study of septic versus aseptic revisions. J Arthroplasty 2014;29(6):1216-8. https://doi.org/ 10.1016/j.arth.2013.11.026
6. Sinclair ST, Orr MN, Rothfusz CA, Klika AK, McLaughlin JP, Piuzzi NS. Understanding the 30-day mortality
burden after revision total knee arthroplasty. Arthroplast Today 2021;11:205-11. https://doi.org/10.1016/j.artd.2021.08.019
7. Kee JR, Mears SC, Edwards PK, Barnes CL. Modifiable risk factors are common in early revision hip and knee
arthroplasty. J Arthroplasty 2017;32(12):3689-92. https://doi.org/10.1016/j.arth.2017.07.005
8. MacMahon A, Rao SS, Chaudhry YP, Hasan SA, Epstein JA, et al. Preoperative patient optimization in total joint
arthroplasty—The paradigm shift from preoperative clearance: A narrative review. HSS J 2022;18(3):418-27.
https://doi.org/10.1177/15563316211030923
9. Morrison TA, Figgie M, Miller AO, Goodman SM. Periprosthetic joint infection in patients with inflammatory joint disease: a review of risk factors and current approaches to diagnosis and management. HSS J 2013;9(2):183-94. https://doi.org/10.1007/s11420-013-9338-8
10. Ministerio de Salud de la Nación Argentina. https://www.argentina.gob.ar/salud/alimentacion-saludable/obesidad. Fecha de último ingreso: 10 de agosto de 2022.
11. Harms S, Larson R, Sahmoun AE, Beal JR. Obesity increases the likelihood of total joint replacement surgery
among younger adults. Int Orthop 2007;31(1):23-6. https://doi.org/10.1007/s00264-006-0130-y
12. Boyce L, Prasad A, Barrett M, Dawson-Bowling S, Millington S, et al. The outcomes of total knee arthroplasty
in morbidly obese patients: A systematic review of the literature. Arch Orthop Trauma Surg 2019;139(4):553-60.
https://doi.org/10.1007/s00402-019-03127-5
13. Ng HJH, Loke WJ, James WLH. The influence of obesity on unicompartmental knee arthroplasty outcomes: A
systematic review and meta-analysis. Arch Bone Jt Surg 2021;9(6):618-32. https://doi.org/10.22038/ABJS.2021.57357.2842
14. McArthur BA, Vulcano E, Cross M, Nguyen J, Della Valle AG, Salvati E. Acetabular component orientation in total hip arthroplasty: the impact of obesity. Hip Int 2014;24(3):263-9. https://oi.org/10.5301/hipint.5000125
15. AOS Workgroup on Obesity. Position statement: The impact of obesity on bone and joint health. Rosemont, IL: American Academy of Orthopaedic Surgeons, 2015. Disponible en: https://www.aaos.org/contentassets/1cd7f41417ec4dd4b5c4c48532183b96/1184-the-impact-of-obesity-on-bone-and-joint-health1.pdf
16. Ellsworth B, Kamath AF. Malnutrition and Total Joint Arthroplasty. J Nat Sci 2016;2(3):e179. PMID: 27376151.
17. Bala A, Ivanov DV, Huddleston JI 3rd, Goodman SB, Maloney WJ, Amanatullah DF. The cost of malnutrition in
total joint arthroplasty. J Arthroplasty 2020;35(4):926-32. https://doi.org/10.1016/j.arth.2019.11.018
18. Evans RP, Clyburn TA, Moucha CS, Prokuski L. Surgical site infection prevention and control: an emerging
paradigm. Instr Course Lect 2011;60:539. PMID: 21553796.
19. Australian Commission on Safety and Quality in Health Care. Osteoarthritis of the knee clinical care standard. Sydney, NSW: ACSQHC, 2017.
20. Kobylińska M, Antosik K, Decyk A, Kurowska K. Malnutrition in obesity: Is it possible? Obes Facts 2022;15(1):19-25. https://doi.org/10.1159/000519503
21. Ministerio de Salud de la Nación. https://www.ms.gba.gov.ar/sitios/media/files/2021/06/Situación-EpidemiológicaTabaquismo-PBA-2021pdf.pdf. Fecha de último ingreso: 10 de agosto de 2022.
22. Jones RE. Wound healing in total joint arthroplasty. Orthopedics 2010;33(9):660. https://doi.org/10.3928/01477447-20100722-35
23. Singh JA. Smoking and outcomes after knee and hip arthroplasty: a systematic review. J Rheumatol.
2011;38(9):1824-34. https://doi.org/10.3899/jrheum.101221
24. Alamanda VK, Springer BD. Perioperative and modifiable risk factors for periprosthetic joint infections (PJI) and recommended guidelines. Curr Rev Musculoskelet Med 2018;11(3):325-31. https://doi.org/ 10.1007/s12178-018-9494-z
25. Bedard NA, DeMik DE, Owens JM, Glass NA, DeBerg J, et al. Tobacco use and risk of wound complications and periprosthetic joint infection: A systematic review and meta-analysis of primary total joint arthroplasty procedures. J Arthroplasty 2019;34(2):385-96e384. https://doi.org/10.1016/j.arth.2018.09.089
26. Moller AM, Villebro N, Pedersen T, et al. Effect of preoperative smoking intervention on postoperative
complications: a randomised clinical trial. Lancet 2002;359(9301):114-7. https://doi.org/10.1016/S0140-6736(02)07369-5
27. Lindström D, Sadr Azodi O, Wladis A, Tønnesen H, Linder S, Nåsell H, Ponzer S, Adami J. Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial. Ann Surg
2008;248(5):739-45. https://doi.org/10.1097/SLA.0b013e3181889d0d
28. Principales resultados de la 4° Encuesta Nacional de Factores de Riesgo 2018. Comparación con las ediciones 2005, 2009 y 2013 (autorreporte) y mediciones objetivas (físicas y bioquímicas). Instituto Nacional de Estadística y Censos - INDEC; Ciudad Autónoma de Buenos Aires: Secretaría de Gobierno de Salud de la Nación. 2019.
29. Iorio R, Williams KM, Marcantonio AJ, Specht LM, Tilzey JF, Healy WL. Diabetes mellitus, hemoglobin A1C, and
the incidence of total joint arthroplasty infection. J Arthroplasty 2012;27(5):726-9. https://doi.org/10.1016/j.arth.2011.09.013
30. Bolognesi MP, Marchant MH, Viens NA, Cook C, Pietrobon R, Vail TP. The impact of diabetes on perioperative
patient outcomes after total hip and total knee arthroplasty in the United States. J Arthroplasty 2008;23(6 Suppl
1):92-8. https://doi.org/10.1016/j.arth.2008.05.012
31. Fisher DA, Dierckman B, Watts MR, Davis K. Looks good but feels bad: factors that contribute to poor results after total knee arthroplasty. J Arthroplasty 2007;22(6 Suppl 2):39-42. https://doi.org/10.1016/j.arth.2007.04.011
32. Hu FB, Stampfer MJ, Haffner SM, Solomon CG, Willett WC, Manson JE. Elevated risk of cardiovascular disease
prior to clinical diagnosis of type 2 diabetes. Diabetes Care 2002;25(7):1129-34. https://doi.org/10.2337/diacare.25.7.1129
33. Gray CS, Scott JF, French JM, Alberti KGMM, O’Connell JE. Prevalence and prediction of unrecognised diabetes
mellitus and impaired glucose tolerance following acute stroke. Age Ageing 2004;33(1):71-7.
https://doi.org/10.1093/ageing/afh026
34. Blanc BF, Hallberg L, Herbert V, Lawkowics W. Nutritional anaemias. Report of a WHO Scientific Group. WHO
Tech Rep Ser 1968:1-40.
35. Marín GH, Rivadulla P, Negro L, Gelemur M, Etchegoyen G; GIS. Estudio poblacional de prevalencia de anemia en población adulta de Buenos Aires, Argentina [Population study of the prevalence of anaemia in the adult population of Buenos Aires, Argentina]. Aten Primaria 2008 Mar;40(3):133-8. https://doi.org/10.1157/13116628
36. Yue C, Kang P, Yang P, Xie J, Pei F. Topical application of tranexamic acid in primary total hip arthroplasty: a
randomized double-blind controlled trial. J Arthroplasty 2014;29(12):2452-6. https://doi.org/10.1016/j.arth.2014.03.032
37. Spahn DR. Anemia and patient blood management in hip and knee surgery. Anesthesiology 2010;113(2):482-95. https://doi.org/10.1097/ALN.0b013e3181e08e97
38. Bailey A, Eisen I, Palmer A, Ottawa Arthroplasty Blood Preservation Group, Beaulé PE, Fergusson DA, et al.
Preoperative Anemia in Primary Arthroplasty Patients-Prevalence, Influence on Outcome, and the Effect of
Treatment. J Arthroplasty 2021;36(7):2281-9. https://doi.org/10.1016/j.arth.2021.01.018
39. Greenky M, Gandhi K, Pulido L, Restrepo C, Parvizi J. Preoperative anemia in total joint arthroplasty: Is it
associated with periprosthetic joint infection? Clin Orthop Relat Res 2012;470(10):2695-701. https://doi.org/10.1007/s11999-012-2435-z
40. Viola J, Gomez MM, Restrepo C, Maltenfort MG, Parvizi J. Preoperative anemia increases postoperative
complications and mortality following total joint arthroplasty. J Arthroplasty 2015;30(5):846-8. https://doi.org/10.1016/j.arth.2014.12.026
41. Petis SM, Lanting BA, Vasarhelyi EM, Naudie DDR, Ralley FE, Howard JL. Is there a role for preoperative iron
supplementation in patients preparing for a total hip or total knee arthroplasty? J Arthroplasty 2017;32(9):2688-93. https://doi.org/10.1016/j.arth.2017.04.029
42. Auron M, Duran Castillo MY. Preoperative anemia optimization: role of iron supplementation. J Xiangya Med
2018;3:37. https://doi.org/10.21037/jxym.2018.09.05
following total knee arthroplasty. J Arthroplasty 2015;30(12):2164-6. https://doi.org/10.1016/j.arth.2015.05.052
2. Fernández-Fernández R, Oñorbe-San Francisco F, Gil-Garay E. Long-term outcomes of a titanium-encased ceramic liner total hip arthroplasty (15 to 21year results). J Arthroplasty 2021;36(11):3697-702.
https://doi.org/10.1016/j.arth.2021.06.016
3. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007;89(4):780-5. https://doi.org/10.2106/JBJS.F.00222
4. Wall C, de Steiger R. Pre-operative optimisation for hip and knee arthroplasty: Minimise risk and maximise
recovery. Aust J Gen Pract 2020;49(11):710714. https://doi.org/10.31128/AJGP-05-20-5436
5. Choi HR, Bedair H. Mortality following revision total knee arthroplasty: a matched cohort study of septic versus aseptic revisions. J Arthroplasty 2014;29(6):1216-8. https://doi.org/ 10.1016/j.arth.2013.11.026
6. Sinclair ST, Orr MN, Rothfusz CA, Klika AK, McLaughlin JP, Piuzzi NS. Understanding the 30-day mortality
burden after revision total knee arthroplasty. Arthroplast Today 2021;11:205-11. https://doi.org/10.1016/j.artd.2021.08.019
7. Kee JR, Mears SC, Edwards PK, Barnes CL. Modifiable risk factors are common in early revision hip and knee
arthroplasty. J Arthroplasty 2017;32(12):3689-92. https://doi.org/10.1016/j.arth.2017.07.005
8. MacMahon A, Rao SS, Chaudhry YP, Hasan SA, Epstein JA, et al. Preoperative patient optimization in total joint
arthroplasty—The paradigm shift from preoperative clearance: A narrative review. HSS J 2022;18(3):418-27.
https://doi.org/10.1177/15563316211030923
9. Morrison TA, Figgie M, Miller AO, Goodman SM. Periprosthetic joint infection in patients with inflammatory joint disease: a review of risk factors and current approaches to diagnosis and management. HSS J 2013;9(2):183-94. https://doi.org/10.1007/s11420-013-9338-8
10. Ministerio de Salud de la Nación Argentina. https://www.argentina.gob.ar/salud/alimentacion-saludable/obesidad. Fecha de último ingreso: 10 de agosto de 2022.
11. Harms S, Larson R, Sahmoun AE, Beal JR. Obesity increases the likelihood of total joint replacement surgery
among younger adults. Int Orthop 2007;31(1):23-6. https://doi.org/10.1007/s00264-006-0130-y
12. Boyce L, Prasad A, Barrett M, Dawson-Bowling S, Millington S, et al. The outcomes of total knee arthroplasty
in morbidly obese patients: A systematic review of the literature. Arch Orthop Trauma Surg 2019;139(4):553-60.
https://doi.org/10.1007/s00402-019-03127-5
13. Ng HJH, Loke WJ, James WLH. The influence of obesity on unicompartmental knee arthroplasty outcomes: A
systematic review and meta-analysis. Arch Bone Jt Surg 2021;9(6):618-32. https://doi.org/10.22038/ABJS.2021.57357.2842
14. McArthur BA, Vulcano E, Cross M, Nguyen J, Della Valle AG, Salvati E. Acetabular component orientation in total hip arthroplasty: the impact of obesity. Hip Int 2014;24(3):263-9. https://oi.org/10.5301/hipint.5000125
15. AOS Workgroup on Obesity. Position statement: The impact of obesity on bone and joint health. Rosemont, IL: American Academy of Orthopaedic Surgeons, 2015. Disponible en: https://www.aaos.org/contentassets/1cd7f41417ec4dd4b5c4c48532183b96/1184-the-impact-of-obesity-on-bone-and-joint-health1.pdf
16. Ellsworth B, Kamath AF. Malnutrition and Total Joint Arthroplasty. J Nat Sci 2016;2(3):e179. PMID: 27376151.
17. Bala A, Ivanov DV, Huddleston JI 3rd, Goodman SB, Maloney WJ, Amanatullah DF. The cost of malnutrition in
total joint arthroplasty. J Arthroplasty 2020;35(4):926-32. https://doi.org/10.1016/j.arth.2019.11.018
18. Evans RP, Clyburn TA, Moucha CS, Prokuski L. Surgical site infection prevention and control: an emerging
paradigm. Instr Course Lect 2011;60:539. PMID: 21553796.
19. Australian Commission on Safety and Quality in Health Care. Osteoarthritis of the knee clinical care standard. Sydney, NSW: ACSQHC, 2017.
20. Kobylińska M, Antosik K, Decyk A, Kurowska K. Malnutrition in obesity: Is it possible? Obes Facts 2022;15(1):19-25. https://doi.org/10.1159/000519503
21. Ministerio de Salud de la Nación. https://www.ms.gba.gov.ar/sitios/media/files/2021/06/Situación-EpidemiológicaTabaquismo-PBA-2021pdf.pdf. Fecha de último ingreso: 10 de agosto de 2022.
22. Jones RE. Wound healing in total joint arthroplasty. Orthopedics 2010;33(9):660. https://doi.org/10.3928/01477447-20100722-35
23. Singh JA. Smoking and outcomes after knee and hip arthroplasty: a systematic review. J Rheumatol.
2011;38(9):1824-34. https://doi.org/10.3899/jrheum.101221
24. Alamanda VK, Springer BD. Perioperative and modifiable risk factors for periprosthetic joint infections (PJI) and recommended guidelines. Curr Rev Musculoskelet Med 2018;11(3):325-31. https://doi.org/ 10.1007/s12178-018-9494-z
25. Bedard NA, DeMik DE, Owens JM, Glass NA, DeBerg J, et al. Tobacco use and risk of wound complications and periprosthetic joint infection: A systematic review and meta-analysis of primary total joint arthroplasty procedures. J Arthroplasty 2019;34(2):385-96e384. https://doi.org/10.1016/j.arth.2018.09.089
26. Moller AM, Villebro N, Pedersen T, et al. Effect of preoperative smoking intervention on postoperative
complications: a randomised clinical trial. Lancet 2002;359(9301):114-7. https://doi.org/10.1016/S0140-6736(02)07369-5
27. Lindström D, Sadr Azodi O, Wladis A, Tønnesen H, Linder S, Nåsell H, Ponzer S, Adami J. Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial. Ann Surg
2008;248(5):739-45. https://doi.org/10.1097/SLA.0b013e3181889d0d
28. Principales resultados de la 4° Encuesta Nacional de Factores de Riesgo 2018. Comparación con las ediciones 2005, 2009 y 2013 (autorreporte) y mediciones objetivas (físicas y bioquímicas). Instituto Nacional de Estadística y Censos - INDEC; Ciudad Autónoma de Buenos Aires: Secretaría de Gobierno de Salud de la Nación. 2019.
29. Iorio R, Williams KM, Marcantonio AJ, Specht LM, Tilzey JF, Healy WL. Diabetes mellitus, hemoglobin A1C, and
the incidence of total joint arthroplasty infection. J Arthroplasty 2012;27(5):726-9. https://doi.org/10.1016/j.arth.2011.09.013
30. Bolognesi MP, Marchant MH, Viens NA, Cook C, Pietrobon R, Vail TP. The impact of diabetes on perioperative
patient outcomes after total hip and total knee arthroplasty in the United States. J Arthroplasty 2008;23(6 Suppl
1):92-8. https://doi.org/10.1016/j.arth.2008.05.012
31. Fisher DA, Dierckman B, Watts MR, Davis K. Looks good but feels bad: factors that contribute to poor results after total knee arthroplasty. J Arthroplasty 2007;22(6 Suppl 2):39-42. https://doi.org/10.1016/j.arth.2007.04.011
32. Hu FB, Stampfer MJ, Haffner SM, Solomon CG, Willett WC, Manson JE. Elevated risk of cardiovascular disease
prior to clinical diagnosis of type 2 diabetes. Diabetes Care 2002;25(7):1129-34. https://doi.org/10.2337/diacare.25.7.1129
33. Gray CS, Scott JF, French JM, Alberti KGMM, O’Connell JE. Prevalence and prediction of unrecognised diabetes
mellitus and impaired glucose tolerance following acute stroke. Age Ageing 2004;33(1):71-7.
https://doi.org/10.1093/ageing/afh026
34. Blanc BF, Hallberg L, Herbert V, Lawkowics W. Nutritional anaemias. Report of a WHO Scientific Group. WHO
Tech Rep Ser 1968:1-40.
35. Marín GH, Rivadulla P, Negro L, Gelemur M, Etchegoyen G; GIS. Estudio poblacional de prevalencia de anemia en población adulta de Buenos Aires, Argentina [Population study of the prevalence of anaemia in the adult population of Buenos Aires, Argentina]. Aten Primaria 2008 Mar;40(3):133-8. https://doi.org/10.1157/13116628
36. Yue C, Kang P, Yang P, Xie J, Pei F. Topical application of tranexamic acid in primary total hip arthroplasty: a
randomized double-blind controlled trial. J Arthroplasty 2014;29(12):2452-6. https://doi.org/10.1016/j.arth.2014.03.032
37. Spahn DR. Anemia and patient blood management in hip and knee surgery. Anesthesiology 2010;113(2):482-95. https://doi.org/10.1097/ALN.0b013e3181e08e97
38. Bailey A, Eisen I, Palmer A, Ottawa Arthroplasty Blood Preservation Group, Beaulé PE, Fergusson DA, et al.
Preoperative Anemia in Primary Arthroplasty Patients-Prevalence, Influence on Outcome, and the Effect of
Treatment. J Arthroplasty 2021;36(7):2281-9. https://doi.org/10.1016/j.arth.2021.01.018
39. Greenky M, Gandhi K, Pulido L, Restrepo C, Parvizi J. Preoperative anemia in total joint arthroplasty: Is it
associated with periprosthetic joint infection? Clin Orthop Relat Res 2012;470(10):2695-701. https://doi.org/10.1007/s11999-012-2435-z
40. Viola J, Gomez MM, Restrepo C, Maltenfort MG, Parvizi J. Preoperative anemia increases postoperative
complications and mortality following total joint arthroplasty. J Arthroplasty 2015;30(5):846-8. https://doi.org/10.1016/j.arth.2014.12.026
41. Petis SM, Lanting BA, Vasarhelyi EM, Naudie DDR, Ralley FE, Howard JL. Is there a role for preoperative iron
supplementation in patients preparing for a total hip or total knee arthroplasty? J Arthroplasty 2017;32(9):2688-93. https://doi.org/10.1016/j.arth.2017.04.029
42. Auron M, Duran Castillo MY. Preoperative anemia optimization: role of iron supplementation. J Xiangya Med
2018;3:37. https://doi.org/10.21037/jxym.2018.09.05