PIG Meeting: 22nd April 2021
64-year-old lady for a Left TKR. Currently housebound and immobile following right TKR.
- Right TKR in 2018 complicated by femoral condyle fracture intraoperatively
- Partial weight-bearing postoperatively and unable to participate in rehabilitation
- Currently housebound, no physical activity
- Multiple previous postponements from perioperative clinic and one cancellation on day of surgery for medical optimisation
- Morbidly obese, BMI 50
- Very complex social situation, husband working full time and is her carer
- Bilateral rotator cuff tears – may not be able to use forearm support frame postoperatively
- Attended rehabilitation last year and engaged well with services
- Lost 30kg with diet and exercise program
- Stopped attending due to distance – patient is from Taree and was travelling to Newcastle
- Poor understanding of perioperative risk.
- Patient and husband very keen for surgery to proceed
1. Should surgery proceed?
- High risk for postoperative complications including joint infection
- Unlikely to be physically fit to participate in rehabilitation in current condition
- Surgical team unaware of booking for surgery and thought ‘she hadn’t been cleared by anaesthetics to proceed.’
2. Can this patient be optimised preoperatively?
- Immobility – re-engage with physiotherapy and rehabilitation services
- Previous effective weight loss with dietician input, new referral
- Social issues, is husband struggling to cope? Would help from outside the home alleviate some stressors?
- Consider home modifications to help patient to manage ADL’s alone
- Multi-disciplinary input required from physio, OT, dietician, and social work.
- Review in 6 weeks