73-year-old man with bilateral knee OA for consideration of single/bilateral knee replacements
- OSA – home CPAP. Compliant
- BMI 37
- IDDM – Hba1c = 7.5%
- Asthma – not known to respiratory physician. Uses salbutamol 5-6 times per day, including overnight.
- Ex-smoker – 10 pack years
- Noted to have NYHA class-4 dyspnoea at periop clinic
- Spirometry performed which showed: FEV 1 = 1.1 (46%) FVC = 1.9 (56%)
- Confirmed with formal spirometry – moderate restrictive defect with no significant BD response
- Seen at Rapid-access respiratory clinic – advised a short course of steroids and triple inhaler therapy
Bilateral joint replacements
- Patients often referred for consideration of bilateral joints
- Surgical team usually requesting procedure to be guided by anaesthetic assessment
- No formal guideline for patient selection but consensus would be an ASA 1/2 patient who is normally fit and active
- This patient would not be suitable for bilateral joint replacements. Increased risk of postoperative pulmonary complications, infection, and MACE.
- Suitable to proceed with single joint replacement
- Optimised from respiratory perspective.
- Proceed with single joint replacement