Recipes for Success in Total Knee Arthroplasty
How do highly experienced orthopaedic surgeons manage the routine questions related to performing total knee arthroplasty, such as:
- Is it acceptable to operate on smokers?
- Should all patients use mupirocin before surgery?
- What are the preferred prophylactic antibiotics – and how long should they be given?
- Is tranexamic acid appropriate for all patients?
- Which pain medications are being prescribed for patients at discharge?
At ICJR’s annual Winter Hip & Knee Course, David F. Dalury, MD, from Towson Orthopaedic Associates in Maryland, asked these questions – and many more – of an elite panel of experienced joint replacement surgeons, including:
- Walter B. Beaver Jr, MD
- Daniel J. Berry, MD
- Mark W. Pagnano, MD
- H. Del Schutte, MD
- Scott M. Sporer, MD
Click the image above to hear what they had to say about the following topics:
- Age: upper or lower limit
- Body mass index
- Hemoglobin A1c
- Preoperative blood donation
- Check for urinary tract infection
- Preoperative dental evaluation
- Preoperative patient education class
- Clearance by a primary care provider
- Testing for methicillin-resistant Staphylococcus aureus (MRSA)
- Mupirocin use
- Preoperative skin cleanse
- Shaving patients
- Prep in the operating room: 1 or 2
- Sterile drapes
- Choice and duration of intravenous (IV) antibiotics
- IV antibiotics for patients with penicillin allergy
- IV antibiotics for MRSA-positive patients
Intraoperative and Postoperative Management
- Type of anesthesia: spinal versus general versus both
- Peripheral nerve blocks
- Tourniquet use: duration of procedure versus during cementation only
- Tranexamic acid: type, recipe, exclusions
- Spray or wands for blood conservation
- Iodine irrigation
- Drains, indwelling urinary catheters, straight catheters
- Cement technique: number of packs, number of mixings, medium or high viscosity
- Wound closure: capsular, skin, dressings
- Pain control: local infiltration, discharge medication
The faculty have no disclosures relevant to this article.