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?

    RELATED: Register for ICJR’s 11th Annual Winter Hip & Knee Course

    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:

    Patient selection

    • Age: upper or lower limit
    • Body mass index
    • Hemoglobin A1c
    • Smokers
    • Preoperative blood donation
    • Check for urinary tract infection
    • Preoperative dental evaluation
    • Preoperative patient education class

    Preoperative Management

    • 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
    • Anticoagulation


    The faculty have no disclosures relevant to this article.