What medical factors require preoperative attention in patients undergoing total joint replacement?
All surgical candidates for orthopedic reconstructive procedures require a comprehensive history and physical examination to assess the overall general operative risks. Patients should be examined for carious teeth, skin ulcerations (especially around the feet), and symptoms of urinary tract infection or prostatism because these could increase the risk of postoperative infections. Women should have a urine culture to rule out asymptomatic bacteriuria. If patients are receiving nonsteroidal antiinflammatory drugs (NSAIDs), these medications should be switched to a COX-2-specific NSAID or stopped several days (at least five half-lives) before surgery to prevent bleeding as a result of their antiplatelet effects. Holding at least one dose of methotrexate and a biologic should be considered.
