2. Preoperative management

The challenge for the patients begins with the initial consultation and the decision to undergo total knee arthroplasty (TKA). It is important to select appropriate candidates and optimize every facet of their condition [7]. There are several key factors that should be considered to minimize the risks of complications and comorbidities [8].

#### 2.1. Preoperative patient assessment

The preoperative assessment should always start with a thorough history taking. Patients often reported pain, functional deficit, or other instability symptoms. The location, duration, severity, character, alleviating and aggravating factors should be obtained in detail. The patients' baseline activity level and past medical history including underlying systemic disease, surgical history, anesthetic history, allergic history, social history and current medication should be recorded. Identification of the unfavorable conditions such as preoperative anemia or coagulopathy is important to reduce the potential complications and comorbidities. Also, previous surgical and non-surgical treatment should be documented. Patient's occupation, leisure hobbies and expectation toward surgical outcomes are inquired.

Complete physical examination is mandatory, including gait observation, inspection, palpation, measurement of range of motion, contractures and ligament stability. Gait observation is mainly looking for the presence of antalgic gait pattern and the requirement of walking aids. Inspection of the patients includes skin change, swelling, and associated deformity of the knee. Following palpation should identify the area of tenderness, severity of effusion, crepitus and patellar tracking. Measurement of range of motion, contractures and ligament stability are also needed.
