Pre-operative optimisation for hip and knee arthroplasty: Minimise risk and maximise recovery
Christopher J Wall, Richard de Steiger
Abstract
BACKGROUND: Osteoarthritis of the hip and knee is a common cause of pain and reduced mobility. Arthroplasty reliably improves quality of life for most patients when non-operative measures have failed. However, hip and knee arthroplasties are major operations that carry significant risks, including the need for revision surgery. OBJECTIVE: The purpose of this article is to discuss pre-operative patient optimisation prior to arthroplasty to minimise risks and maximise recovery. DISCUSSION: Recent literature has identified a number of modifiable factors that increase the risk of post-operative complications following arthroplasty. These include obesity, diabetes, tobacco use, opioid use, anaemia, malnutrition, poor dentition and vitamin D deficiency. Addressing these factors prior to arthroplasty may reduce the risk of adverse outcomes. Pre-operative education and exercise, termed prehabilitation, has an important role in optimising patient outcomes following hip and knee arthroplasty. Participation in a prehabilitation program prior to arthroplasty is recommended.