PIG Meeting: 11th March 2021

73 year old man for unicompartmental knee replacement

Background

• Mild OA of knee, restricting ability to play golf
• Good exercise tolerance. DASI 7 METS
• IHD – stents in 2000 and 2008. No follow up or symptoms since
• Type 2 diabetes. Excellent glycaemic control

Issues

• Positive sestamibi – RCA territory. Report states “test in isolation puts the patient into the moderate to high-risk category for perioperative cardiac event.”
• Asymptomatic for many years and also during sestamibi.
• Minimal knee symptoms, limiting golfing only.
• Discussed at cardiology meeting, Dr Collins recommended cardiology appointment and angiogram
• Reviewed by different cardiologist at clinic, outcome was to proceed with surgery and have angiogram post-operatively

Discussion

• Awkward situation!
• Many valid points raised regarding appropriateness of test in first instance
• Consensus was to proceed with surgery as clinic cardiologist has reviewed the patient face to face and made an objective clinical assessment.
• Perioperative troponin – should we consider in this patient? Agreed that this was a valid consideration but not practical as there is no current consensus in JHH on where and how to treat if raised post-operative troponin.

Plan

• Proceed to surgery
• Discuss case with procedural anaesthetist
• Consider BNP. Most agreed that patient has had adequate perioperative risk assessment adding BNP unlikely to change management at JHH.