Optimizing Important Comorbidities: Diabetes, Rheumatoid Arthritis, Peripheral Vascular Disease, and Cardiac Disease

The decision to recommend any surgery hinges not only on the severity of pathology but also on the various risk factors the patient has while undergoing surgery. The risk–benefit analysis is an integral part of any surgeon’s thought process when offering surgery. Any surgical procedure can be classified into four categories based on anticipated risk and anticipated benefit. In general, surgery is not recommended when the anticipated benefit is low. The ideal scenario is low risk and high benefit, thereby maximizing the success of any surgery. Sometimes it may be necessary to face a scenario where the risk is high but the potential benefit is also high (high risk, high benefit). In this case, it is important to establish if the risk is modifiable and involve the patient and the primary health care provider in risk mitigation by setting reasonable, acievable goals using team approach. This chapter deals with optimizing diabetes, rheumatoid arthritis, peripheral vascular disease, and cardiac disease before a total knee arthroplasty.