What preoperative assessments are performed before knee replacement surgery?

Before knee replacement surgery, several preoperative assessments are conducted to ensure that the patient is medically fit for the procedure and to optimize the surgical outcome. These assessments are crucial to assess the patient’s overall health status, identify potential risks, and plan for a successful surgery and recovery. 

Here are the key preoperative assessments typically performed before knee replacement surgery:

1. Medical History Review:

• Current Symptoms: Assess the severity of knee pain, stiffness, and functional limitations.
• Past Medical History: Identify any chronic medical conditions such as diabetes, hypertension, heart disease, or lung disease.
• Previous Surgeries: Document any prior surgeries, especially those involving the knee joint.
• Medications: Review current medications, including prescription drugs, over-the-counter medications, and supplements.
• Allergies: Verify any known allergies, especially to medications or materials used in implants.

2. Physical Examination:

• Joint Evaluation: Assess the knee joint for range of motion, stability, deformities, and signs of inflammation.
• Muscle Strength: Evaluate the strength and function of muscles around the knee joint.
• Gait Analysis: Observe the patient’s walking pattern and identify any abnormalities or compensations.

3. Imaging Studies:

• X-rays: Provide detailed images of the knee joint to assess the extent of joint damage, deformities, and bone quality.
• MRI (Magnetic Resonance Imaging): May be used to further evaluate soft tissues such as ligaments, tendons, and cartilage if needed.

4. Laboratory Tests:

• Blood Tests: Check for complete blood count (CBC), electrolyte levels, kidney function, liver function, and blood clotting profile (PT/INR, PTT).
• Urine Tests: Screen for urinary tract infections or other abnormalities.

5. Cardiovascular Assessment:

• Electrocardiogram (ECG): Evaluates heart rhythm and function, especially in patients with a history of heart disease or hypertension.
• Cardiac Stress Test: May be recommended for patients with significant cardiovascular risk factors to assess heart function under stress.

6. Pulmonary Evaluation:

• Pulmonary Function Tests (PFTs): Assess lung function, especially in patients with a history of smoking, lung disease, or obesity.

7. Anesthesia Evaluation:

• Anesthesia Consultation: Determine the appropriate anesthesia technique based on the patient’s health status and preferences.
• Discussion of Anesthesia Options: Review the risks, benefits, and potential complications associated with different anesthesia methods.

8. Dental Evaluation:

• Dental Examination: Identify any active infections, dental problems, or risk factors for infection that could affect the surgery.

9. Nutritional Assessment:

• Nutritional Status: Evaluate nutritional deficiencies or conditions that could impact healing and recovery post-surgery.

10. Psychosocial Evaluation:

• Mental Health Assessment: Screen for anxiety, depression, or other psychological factors that could affect recovery and adherence to post-operative care.

11. Medication Review and Optimization:

• Medication Management: Adjust medications as needed to optimize perioperative management, including pain control, blood pressure management, and infection prevention.

Conclusion:

Preoperative assessments before knee replacement surgery are comprehensive and aim to ensure that the patient is well-prepared physically and psychologically for the procedure. These assessments help identify and manage any underlying health issues, minimize surgical risks, and improve overall outcomes and patient satisfaction.