[Pre-operative Evaluation of Patients Undergoing Total Joint Arthroplasty - What is Essential?]

Background A thorough pre-operative evaluation is required prior to total joint arthroplasty (TJA). The objective of screening is to identify patient- and procedure-related risk constellations. Pre-operative diagnostic measures are vital in order to anticipate, reduce or even eliminate threats to patient safety. Furthermore, the clinical and radiographical workup may confirm the indication and type of surgical procedure, but this is not the subject of this article. Objective An overview of the current literature on pre-operative diagnostic principles is presented. Methods A selective literature analysis was performed. Results We identified recommendations related to the following: (1) preoperative anaemia, (2) metabolic optimisation, (3) weight control, (4) obstructive sleep apnoea, (5) MRSA and skin decontamination, (6) urinary tract infections (UTI), (7) dental screening (8) cardiological workup, (9) technical considerations on primary and revision arthroplasty. Conclusion While clear evidence-based recommendations for every item are not yet available, a critical pre-operative evaluation including history taking, physical exam, laboratory tests and imaging studies remains essential. The ongoing evolution of improved perioperative care and implications for patient safety will further increase the scope of necessary preoperative diagnostic measures.