NYULMC Biiaterai Total Knee Replacement Protocol Exclusion Criteria 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. Age > 75 years ASA3or4 lschemic Heart Disease {positive stress test) On aggressive anticoagulation or Plavix Have poor ventricular function (LVEF < 50%) Have oxygen dependent pulmonary disease Have renal Insufficiency or end stage renal disease, Cr> 1.6 Have steroid dependent asthma or COPD Have pulmonary hypertension (PAP>45) Are morbidly obese, BMI 40 or greater Have chronic liver disease (Childs class B or worse) Have cerebral vascular disease Have sleep study proven obstructive sleep apnea without treatment, or STOP/BANG >5 Insulin Dependent Diabetes Mellitus, Blood Glucose above 180 History of DVT or PE History of Congestive Heart Failure Hgb < 11 or Jehovah's Witness Guidelines A. Consider echocardiography If there Is a question of right sided heart strain/pulmonary artery hypertension to assess for dysfunction that would preclude Bilateral TKA. B. Anesthesia will make a determination of Inclusion for bilateral, simultaneous TKA at PAT. Anesthesia will Identify those that need an echocardlogram at PAT. C. Consider doing the second TKA of simultaneous bllaterals without tourniquet until the first tourniquet Is down. D. When possible the 2nd knee of a bilaterally Involved patient that does not qualify for same session bilateral TKA should be done 3 months or more after the first knee to avoid VTED Increased risk