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Perioperative management in total knee arthroplasty: patient selection, pain management, thromboprophylaxis, and rehabilitation

Amanatullah, Derek F. MD, PhDa; Pallante, Graham D. MDb; Chalmers, Brian P. MDb; Pagnano, Mark W. MDb; Sierra, Rafael J. MDb

doi: 10.1097/BCO.0000000000000230
SPECIAL FOCUS: Total Joint Reconstruction

Optimization of patient expectations in TKA requires understanding the risk profile of each patient and tailoring preoperative counseling appropriately. There are numerous postoperative thromboprophylaxis regimens, but aspirin has gained consensus approval from the American Academy of Orthopaedic Surgeons and American College of Chest Physicians and may decrease the risk of bleeding when compared to other agents. Early mobilization or mechanical compression remain useful adjuncts to chemical thromboprophylaxis. Pre-emptive multimodal pain control is effective and minimizes narcotic-related side effects. Regional blockade and periarticular injection are effective strategies for site-specific pain control and avoid opioid induced side effects. Strategies for perioperative physical therapy vary widely and there are no well-defined guidelines for postoperative rehabilitation. Rehabilitation lacks durable clinical benefits long-term for the average patient. However, targeted utilization of perioperative rehabilitation to the most debilitated patients may be beneficial.

aStanford University, Department of Orthopaedic Surgery Redwood City, CA

bMayo Clinic, Department of Orthopaedic Surgery, Rochester, MN

Financial Disclosure: Dr. Amanatullah is a consultant for Sanoifi. He has received grants from SUMS and holds patents in DTPFS and Cool Cut. Dr. Pagnano receives royalties from Depuy and Stryker, and Dr. Sierra is a consultant for Biomet. He receives or has received grants and royalties from same. The authors report no conflicts of interest in regards to this manuscript.

Correspondence to Rafael J. Sierra, MD, Mayo Clinic, Department of Orthopaedic Surgery, 200 First Street SW, Gonda 14, Rochester, MN 55905 Tel: (507) 266-2904; fax: (507) 266-4234; e-mail: sierra.rafael@mayo.edu

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