Pre-operative optimisation for hip and knee arthroplasty: Minimise risk and maximise recovery

Osteoarthritis of the hip and knee is a common cause of pain and reduced mobility. Arthroplasty reliably improves quality of life for most patients when non-operative measures have failed. However, hip and knee arthroplasties are major operations that carry significant risks, including the need for revision surgery.

The purpose of this article is to discuss pre-operative patient optimisation prior to arthroplasty to minimise risks and maximise recovery.

Recent literature has identified a number of modifiable factors that increase the risk of post-operative complications following arthroplasty. These include obesity, diabetes, tobacco use, opioid use, anaemia, malnutrition, poor dentition and vitamin D deficiency. Addressing these factors prior to arthroplasty may reduce the risk of adverse outcomes. Pre-operative education and exercise, termed prehabilitation, has an important role in optimising patient outcomes following hip and knee arthroplasty. Participation in a prehabilitation program prior to arthroplasty is recommended.