Before you undergo a total knee replacement (TKR), the surgeon you have selected will conduct a thorough preoperative evaluation. It’s essential that the doctor performing the procedure spend adequate time evaluating your health and verifying that you’re a suitable candidate for a TKR. It’s also critical to conduct routine tests and possibly adjust your current medications to ensure the best clinical result. This review process typically takes place several weeks before a scheduled surgery date.
What Happens in a Preoperative Evaluation for TKR?
The doctor will evaluate your health with you and make sure you are a good candidate for a TKR. Here are several things your doctor will likely review and tests they will order.
Overall Health Review and Checkup
A pre-surgery checkup will provide clues about the state of your overall health and whether you meet the criteria for a TKR. It will also help the surgeon know how to best approach the procedure — particularly if you have conditions such as high blood pressure, blood clotting issues, diabetes, or a cardiac arrhythmia.
Blood and Urine Tests
A doctor will want to know that your key organs, including your liver and kidneys, are healthy before operating. Since it’s not unusual to lose 1,000 to 1,500 milliliters of blood during surgery and recovery, it’s important to know whether you are suffering from anemia or have any other abnormal metabolic functions.
A blood test indicates the blood type that would be needed in the case of a transfusion. If you are unable to bank your own blood, the hospital will require your blood type in order to make a proper match.
Chest X-Ray and EKG
Your doctor may request these tests to ensure that your heart and lungs are healthy enough for surgery. Any type of disease that affects these organs may put you at greater risk of having problems during the surgery, or make it impossible for you to have the surgery entirely.
It’s important for the medical team to conduct a complete review of the medications you take —both over-the-counter and prescription. Your doctor may want to alter your prescriptions, and may advise a change in your over-the-counter drug use.
No surgeon will operate without your informed consent. You will be asked to sign a form that describes the procedures and the devices that will be used. In signing this document, you acknowledge that you understand the operation and recognize the risks.
In almost every state, the law requires that some type of documented informed consent take place. Although it’s impossible to cover the full spectrum of risks involved, it’s important that you know about the procedure and the most frequent complications. The consent process may include questions about your willingness to accept blood transfusions and, in a worst-case scenario, your desires involving life support.
Questions to Ask Your Surgeon Before the Surgery
Understanding the Implant
- Why did you choose the prosthesis you are planning to give me? How long have you been implanting this device in patients?
- Who manufactures this device? Is this the brand of implant you typically use? Do you have a relationship with the maker of the prosthesis you are implanting?
- What is the typical lifespan of the implant? Is there anything I should know about it? Has this device ever been recalled by the FDA?
- What are the advantages and disadvantages of this device compared to others?
- What are your short-term and long-term complication rates for things such as breakage, clicking, the device not working right, and unidentified pain?
- Where will the incision be and what will its size be?
- What type of surgical approach will you take?
- What type of surgical planning will you do?
- Will you use a computer-assisted method?
- How long will the surgery take?
Risks and Complications
- What is your infection rate? (For reference — 0.5 percent or less is considered good.)
- What risks do I face and how likely is it that I’ll face complications?
- What type of anesthesia will you use? What are the risks of anesthesia?
- How long will I be in the hospital?
- How long will the recovery process last? What will it entail?
- How much pain will I have following surgery? What will the pain be like when I get home and start rehab?
- When will the pain go away? What can I do to manage the pain?
- What mobility or movement restrictions or limitations will I have and how long will they last?
- When can I re-start the activities I want to do (i.e., golf, walking)? What activities should I avoid?
- How do you expect my new knee will function in six months? A year?
- Will there be follow-up appointments needed? When will the first follow-up appointment be? And how regularly after that?