PIG Meeting: 11th March 2021
73 year old man for unicompartmental knee replacement
- 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
- 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
- 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.
- 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.