73-year-old man with bilateral knee OA for consideration of single/bilateral knee replacements

Background

• 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

Issues

• 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

Discussion

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.

Optimisation

• Suitable to proceed with single joint replacement
• Optimised from respiratory perspective.

Plan

• Proceed with single joint replacement