Knee arthroplasty

Knee arthroplasty

Anesthesia type	General or spinal Regional
Airway	ETT/LMA if general
Lines and access	PIV
Monitors	Standard 5-lead ECG
Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative
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Knee arthroplasty is a surgical procedure to resurface a knee damaged by arthritis.

Overview

Indications

• Knee arthritis (inflammatory) or arthrosis (non-inflammatory degeneration)
• Infected knee
• Loose or malpositioned knee prothesis

Preoperative management

Patient evaluation

System	Considerations
Airway
Neurologic	Arthritis may impair neck ROM or cause cervical nerve root compression.
Cardiovascular	Patients with arthritis may have limited exercise tolerance due to knee pain, thus impairing assessment of cardiovascular function. Stress echo may be needed for cardiac evaluation.
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other	Patients may have rheumatoid arthritis

Regional and neuraxial techniques

• Adductor canal block
• Femoral nerve block +/- lateral femoral cutaneous
• Sciatic nerve block

Note: Some surgeons will perform a periarticular injection with a long-lasting local anesthetic (i.e. liposomal bupivicaine) prior to emergence.

Intraoperative management

Monitoring and access

• Standard ASA monitors
• PIV

Procedure variants

	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications