Preoperative testing before major surgery

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Submitted by Dr T on February 26, 2013 – 3:17pm

I am 53 and will be having a total knee replacemnt.  I have never had any heart problems and any EKGs that I have ever had  have all been normal.  Why would my orthopedic surgeon want me to have a chemcial stress test?  He states that the AAOS requires this now for patients over the age of 50 for joint replacement.  I am sure that my insurance will not want to pay for this.  I did have one back in 1997 due to a car accident without airbags but the test ws completely normal.  Thank you for any answers to the above.

For a many patients, preoperative testing is appropriate. Whether you are, depends on a number of criteria as outlined in the 2007 ACC/AHA 2007 Guidelines.

Some additional thoughts:

  • If it is an absolute  preoperative requirement your insurance will pay for it. 
  • A 1997 test is not an assurance you have no heart disease 16 years later. 
  • A stress test is an appropriate preoperative test for someone who needs major surgery such as a knee replacement, if it appears their functional status is impaired. 
  • There are guidelines for who should be tested:
    • A good functional status is defined as the ability to exercise at a 7-10 METS level.
      • Functional status can usually be estimated from the ability to perform activities of daily living, and can be expressed as metabolic equivalents (METs); the resting or basal oxygen consumption (VO 2) of a 70kg, 40 years old man in a resting state is 3.5 cc/kg/min, or 1 MET.
  • When you calculate your cardiac risks, you can probably judge whether you should have preoperative testting.

Hope this helps,

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