Does Fluid Replacement From Preoperative NPO Status Improve Postoperative Recovery

Hip and knee arthroplasty are safe and reliable surgeries for the majority of patients, but a
small percentage experience major complications such as myocardial infarction, deep vein
thrombosis (DVT), and pulmonary embolism (PE). As these complications are related to local
tissue hypoxemia and patient immobility, interventions that can improve the ability of the
heart to deliver blood to the tissue and help patients mobilize earlier in their
postoperative course may decrease these complications. Based on recent evidence, it has been
shown that many patients are dehydrated before surgery, which can make them feel nauseous,
tired, and increase their perception of pain making them less likely to mobilize. This
predisposes them to DVTs, pulmonary embolism, nausea and vomiting. Peri-operative dehydration
can also decrease the ability of the lungs to oxygenate the blood properly and can place
additional stress on the heart, which can increase the risk of heart attacks. The specific
aim is to determine if patients' peri-operative hemodynamics can be improved with
preoperative administration of 2 L of lactated ringers, and consequently reduce postoperative
complications and improve recovery in arthroplasty patients.

Inclusion Criteria:

- All patients >= 18 years of age, undergoing a total primary knee or hip arthroplasty

Exclusion Criteria:

- Patients weighing less than 80 kg.

- Patients undergoing irrigation and debridement, explantation, or revision will not be
eligible.

- history of kidney disease, congestive heart failure, pulmonary edema, cirrhosis of the
liver, or history of systemic fluid overloard will be excluded from the study.

- No one will be excluded based on gender, ethnicity or race.