Tough Questions in Total Hip and Total Knee Arthroplasty

Some of today's tough questions surrounding hip and knee arthroplasty involve modifiable risks, bilateral staging, physiotherapy, postoperative activity, venous thromboembolism and infection prophylaxis, pain management, and outpatient settings. The available literature is reviewed to provide answers to difficult questions facing the orthopaedic surgeon. Preoperative questions focus on patient selection, medical optimization, and appropriateness for outpatient surgery. Modifiable risk factors for undergoing lower extremity arthroplasty include obesity, smoking, and diabetic control. Guidelines are presented to advise which patients are suitable candidates to undergo the procedure in an outpatient setting. Perioperative questions arise regarding the use of first-generation cephalosporins for prophylaxis, topical vancomycin powder, tranexamic acid, negative-pressure dressings, local intra-articular injections, and optimal timing of staged bilateral procedures. Postoperative questions are often raised about the necessity of formal postoperative physical therapy, when can patients resume driving after arthroplasty, should patients return to high-level sporting activity, and how long should patients be advised to take antibiotic prophylaxis for dental procedures.