Cardiology conflicting advice

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.