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Preoperative Patient Optimization for Lower Extremity Total Joint Arthroplasty Surgery
Kristen Barton1,2, Jason M Jennings1,3,4, Douglas A Dennis1,3,5,6
1Colorado Joint Replacement, AdventHealth, Denver, Colorado.
JBJS Reviews
|June 20, 2025
Summary
Optimizing patient health before total joint arthroplasty (TJA) can improve outcomes and reduce complications. This involves addressing biological, social, and psychological factors for better surgical care.
Area of Science:
- Orthopedic Surgery
- Patient Optimization
- Arthroplasty Care
Background:
- Medical comorbidities and modifiable risk factors impact total joint arthroplasty (TJA) outcomes.
- Optimization strategies aim to enhance TJA care value and minimize complications.
Purpose of the Study:
- To review and summarize preoperative patient optimization strategies for lower extremity TJA.
- To cover both primary and revision arthroplasty settings.
Main Methods:
- Comprehensive literature review of preoperative optimization strategies.
- Evaluation of modifiable biological, social, and psychological factors.
Main Results:
- Identified key modifiable biological factors: obesity, diabetes, malnutrition, bone health, anemia, bleeding risk, inflammation, S. aureus colonization, and frailty.
- Identified key modifiable social/psychological factors: smoking, alcohol/drug use, mental health, patient education, and discharge planning.
Conclusions:
- Preoperative optimization of modifiable risk factors is crucial for improving TJA outcomes.
- A multidisciplinary approach addressing biological, social, and psychological aspects enhances patient readiness for surgery.
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