Wesley H. Bronson,Melissa Fewer,Karl Godlewski,James D. Slover

Arthur Caplan,Richard Iorio,Joseph Bosco

There are multiple risk factors for complications following elective total joint replacement (TJR) surgery. Certain risk factors, including operating time, implant choice, component positioning, and intraoperative difficulties (e.g., fracture, nerve and vascular damage), are related to the surgeon’s experience and decision-making and are not patient dependent. However, many risk factors for complications after TJR are patient dependent. Bacterial colonization, diabetes control, body mass index (BMI), smoking status, fall risk, narcotic and/or alcohol dependence, physical conditioning, neurocognitive disorders, nutritional status, cardiovascular status, nongenetic thromboembolic risk, and anemia all represent potentially modifiable factors that increase the risk of complication with TJR.

Orthopaedic surgeons routinely perform TJR on patients who have one or more of the above-mentioned risk factors. However, this is elective surgery, and some of these risk factors are modifiable prior to surgery. As a result, ethical questions arise. Should patients address these risk factors prior to undergoing TJR, and to what extent should the physician, payer, and health-care institution require the patient to do so?