What should be checked during a pre-operative examination for a total hip arthroplasty (THA) surgery?

From the Guidelines

For a pre-op exam before total hip surgery, a comprehensive evaluation including a thorough medical history review, physical examination, assessment of cardiovascular and respiratory health, laboratory tests such as complete blood count, metabolic panel, and coagulation studies, review of current medications, imaging studies, and anesthesia risk assessment is essential. This approach is supported by the most recent guidelines, including those from the American College of Rheumatology and the American Association of Hip and Knee Surgeons 1.

When evaluating a patient for total hip arthroplasty (THA), it is crucial to consider their overall health and any potential risks that may impact the surgery or recovery process. Key components of the pre-operative examination include:

• A thorough medical history review to identify any pre-existing conditions that may affect the surgery or recovery
• A physical examination to assess the patient's current health status and identify any potential issues
• Assessment of cardiovascular health, including blood pressure, heart rate, and an ECG if indicated, as patients with signs and symptoms of cardiovascular disease should undergo preoperative electrocardiography 1
• Evaluation of respiratory function, especially if the patient has a history of smoking or lung issues
• Laboratory tests such as complete blood count, metabolic panel, and coagulation studies to identify any potential issues that may impact the surgery or recovery
• Review of current medications, particularly blood thinners like warfarin or aspirin, and adjustment as necessary
• Imaging studies, including X-rays of the hip and possibly an MRI, to evaluate the hip joint and surrounding tissues
• Anesthesia risk assessment to determine the safest approach for the surgery

The decision to perform preoperative testing should be based on the history and physical examination findings, perioperative risk assessment, and clinical judgment 1. Additionally, patients with new or unstable cardiopulmonary signs or symptoms should undergo preoperative chest radiography 1.

It is also important to consider the patient's current medications, particularly antirheumatic medications, and adjust them as necessary according to the most recent guidelines 1. For example, for patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, or juvenile idiopathic arthritis undergoing THA, continuing the usual dosing of certain disease-modifying antirheumatic drugs (DMARDs) through surgery is conditionally recommended 1.

Overall, a comprehensive pre-operative evaluation is essential to ensure the best possible outcomes for patients undergoing total hip arthroplasty.

From the Research

Pre-Operative Examination for Total Hip Arthroplasty (THA) Surgery

The following are some key points to consider during a pre-operative examination for THA surgery:

• Laboratory studies such as prothrombin time (PT) and International Normalized Ratio (INR), complete blood count (CBC), and complete metabolic panel (CMP) should be obtained preoperatively 2
• Electrocardiogram (EKG), chest X-ray, and other preoperative laboratory tests such as RBCs antibody screen, Metabolic Panel, and Urinalysis may also be necessary 3
• Patient demographics and comorbidities should be evaluated to identify risk factors for abnormal or actionable laboratory studies 2
• Preoperative screening should include assessment of hip dysfunction and pain 4
• Preparation of the patient before surgery, such as showing a videotape of the surgery, can help reduce stress and anxiety 5
• Complete blood count (CBC) should be assessed preoperatively to determine the predictive power for transfusion rate 6

Key Laboratory Tests

Some key laboratory tests to consider during a pre-operative examination for THA surgery include:

• Prothrombin time (PT) and International Normalized Ratio (INR) to evaluate blood clotting 2
• Complete blood count (CBC) to evaluate blood cell counts and predict transfusion rate 2, 6
• Complete metabolic panel (CMP) to evaluate kidney and liver function 2
• RBCs antibody screen to evaluate for any antibodies that may affect blood transfusion 3
• Metabolic Panel to evaluate electrolyte and metabolic status 3
• Urinalysis to evaluate kidney function and detect any urinary tract infections 3

Patient Preparation

Patient preparation before THA surgery is crucial to reduce stress and anxiety, and includes:

• Showing a videotape of the surgery to prepare the patient for what to expect 5
• Assessing patient demographics and comorbidities to identify risk factors for abnormal or actionable laboratory studies 2
• Evaluating hip dysfunction and pain to determine the best course of treatment 4