Total Ankle Replacement Surgical Clearance Requirements

When a patient is scheduled for total ankle replacement surgery, a medical clearance is required by all facilities to ensure a safe outcome. It’s important for the patient’s primary care physician to send completed clearance to the surgical facility prior to the procedure.

• History and Physical Exam and Labs are valid for 30 days.
• EKG’s that are normal are valid for 90 days.

ALL PATIENTS require at minimum the following:

1. History & Physical Exam
2. MRSA/MSSA Nasal Swab (must be done at INOVA Pre-Surgical Services: 8503 Arlington Blvd Fairfax, Virginia 22031)

Patients who are 50 years and older or who have diabetes, hypertension or a BMI greater than 35 requires the following:

1. History & Physical Exam Form
2. EKG
3. CBC
4. CMP

Patients with Cardiac Disease (excluding HTN) require the following:

1. H/P form
2. EKG
3. CBC
4. CMP
5. Cardiac clearance

These tests meet the minimum requirements for surgical clearance; further testing is at your discretion.

*Please note patients with a BMI greater than 40 may be required to have an airway evaluation prior to surgery*