mann preoperative and postoperative planning for total
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Disclosures•I have no financial disclosures or conflicts of interest
Special Thanks•Mikayla Coan, PA-S•Amanda Hunnel, RN, BSN
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INITIAL EVALUATION
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Duration of pain Quality of pain Level of activity
Prior injuries or prior knee surgeries • ex: ACL reconstruction
or meniscectomies
Aggravating factors and functional limitations
Alleviating factors and previous treatment • ex: NSAIDs, bracing,
injections, PT
•ex: Nickel •Cobalt Chrome ~ 1% Nickel•Titanium 0.1% Nickel
Allergies
•History of DVT or PE•Treatment for atrial fibrillation or previous VTE
Venous thromboembolism risk
Smoking status
•BMI < 40•Type 2 Diabetes Mellitus – Hgb A1c < 8.0
Comorbid conditions
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• Most important predictor of post-operative ROMPre-operative ROM
Assessment of cruciate and collateral ligaments
Identification of flexion contracture
• “Bow legged” vs “knock kneed” Gait Assessment
Neurovascular assessment
Exam of ipsilateral hip and contralateral hip and knee
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• Standing AP • Standing PA flexion (Rosenberg, Tunnel)• Weight bearing lateral • Patellar sunrise
Plain Radiography
• Femur or tibia/fibula views (if prior surgery with hardware)• Hip to ankle standing alignment views• Advanced imaging (MRI, CT)
• usually only done in pre-operative navigationOptional
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• PATIENT TO BE SEEN NO MORE THAN 30 DAYS PRIOR TO SURGERYFOR PREOPERATIVE HISTORY AND PHYSICAL WITH PRIMARY CARE
• CBC• CMP• HGB A1C
• UA• ALBUMIN
• EKG• CHEST X-RAY
• MAY ALSO NEED CLEARANCE FROM OTHER MEDICALSUBSPECIALTIES
• EX: CARDIOLOGY: ECHOCARDIOGRAPHY, ANTICOAGULATION
• DENTAL WORK COMPLETED PRIOR TO SURGERY
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HTTPS://WWW.AAOS.ORG/GLOBALASSETS/REGISTRIES/2020-AAOS-AJRR-ANNUAL-REPORT-PREVIEW_FINAL.PDF
HTTPS://WWW.ARTHROPLASTYJOURNAL.ORG/ARTICLE/S0883-5403(18)30236-5/ABSTRACT
HTTPS://ORTHOINFO.AAOS.ORG/EN/TREATMENT/TOTAL-KNEE-REPLACEMENT
HTTPS://PUBMED.NCBI.NLM.NIH.GOV/30778723/
HTTPS://PUBMED.NCBI.NLM.NIH.GOV/25404402/
HTTPS://WWW.WHEELESSONLINE.COM/ARTHRITIS/PATHOLOGICAL-FEATURES-OF-OSTEOARTHRITIS/
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