Bilateral TKR

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