Preoperative Patient Optimization for Lower Extremity Total Joint Arthroplasty Surgery

» Identifying medical comorbidities and optimizing modifiable risk factors (biological, social, and psychological) have been suggested as a strategy to improve the value of total joint arthroplasty (TJA) care, while reducing the risk of intraoperative and postoperative complications. Modifiable biological factors include weight management to reduce obesity, optimizing diabetic control, improving malnutrition, optimizing bone health, improving anemia, managing anticoagulants and bleeding risk, controlling inflammatory conditions, reducing methicillin-sensitive Staphylococcus aureus/methicillin-resistant S. aureus colonization, and reducing frailty. Modifiable social and psychological factors include tobacco and smoking cessation, reducing alcohol use, ceasing drug use/misuse, optimizing mental health (i.e., depression, anxiety), patient TJA education and managing expectations, and evaluating discharge determination and living status. This review comprehensively evaluates and summarizes preoperative patient optimization strategies for lower extremity TJA surgery, both in the primary and revision settings.