Modifiable risk factors and preoperative optimization of the primary total arthroplasty patient

The bundle payment system combined with the current medical utilization climate has placed pressure on surgeons to produce excellent results with early functional recovery and short hospital stays after total hip arthroplasty (THA). There is concern that patients with comorbidities may encounter difficulty finding a surgeon willing to perform elective arthroplasty because of their increased risk of complications. Treating modifiable preoperative risk factors can reduce postoperative complications, re-admission rates, length of hospital stay, and adverse surgical outcomes. In this article we review the recent literature on clinical strategies for improving modifiable risk factors to meet patient expectations and achieve good outcomes.