AB0806 The effect of repetitive active range of motion versus continuous passive motion on early functional outcomes after primary total knee replacement

Introduction: The use of peri-articular (PA) tranexamic acid (TXA) and its efficacy in comparison with intra-articular (IA) tranexamic acid has not been well explored in literature. This retrospective cohort study aims to compare the effects of IA and PA TXA with analgesic components in reducing blood loss and improving immediate post-operative pain relief and functional outcomes in unilateral primary total knee replacement (TKA) patients. Methods: 63 patients who underwent a unilateral primary total knee replacement procedure were divided into 2 groups: 42 patients in the IA TXA delivery group, 21 patients in the PA TXA group. 1g of TXA was utilized for all patients. All patients had pericapsular infiltration consisting of 0.5ml of Adrenaline, 0.4ml of Morphine, 1g of Vancomycin, 1ml of Ketorolac and 15ml of Ropivacaine. Outcomes for blood loss, and surrogate markers for immediate functional recovery were measured. Results: 54.0% of the patients were female, 46.0% male. The mean drop in post-operative Hb levels in the PA and IA group was 2.0g/dL and 1.6 g/dL respectively, and statistically insignificant (p=0.10). The mean HCT drop in the PA and IA group was 6.1% and 5.3% respectively and statistically insignificant (p=0.58). The POD 1 and discharge day flexion angles, POD 1 and POD 2 VAS scores, gait distance on discharge, and length of hospitalization stay were largely similar in both groups. Conclusion: Our study shows that both IA and PA TXA with analgesic components are equally efficient in reducing blood loss and improving immediate postoperative pain relief and functional outcomes.

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93 The Effects of Kinesiophobia on Outcome following Total Knee Replacement: A Systematic Review

British Journal of Surgery ◽

10.1093/bjs/znab259.968 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

O Brown ◽

L Hu ◽

C Demetriou ◽

T Smith ◽

C Hing

Keyword(s):

Systematic Review ◽

Total Knee Replacement ◽

Range Of Motion ◽

Knee Replacement ◽

Functional Outcomes ◽

English Language ◽

Psychological Treatment ◽

Functional Score ◽

Case Control Studies ◽

Total Knee

Abstract Aim Kinesiophobia, the fear of physical movement and activity related to injury vulnerability, has been linked to sub-optimal outcomes following total knee replacement (TKR). This systematic review has two aims: to define the relationship between kinesiophobia and functional outcomes, pain and range of motion following TKR, and to evaluate published treatments for kinesiophobia following TKR. Method A primary search was performed in March 2020. English-language studies recruiting adult primary TKR patients, using the Tampa Scale of Kinesiophobia (TSK) were included. Study quality was assessed using the Newcastle Ottawa Scale for cohort or case control studies, and the Cochrane Collaboration Risk of Bias tool for randomised controlled trials. Results All thirteen included papers (82 identified) showed adequately low risk of methodological bias. TSK1 (activity avoidance) correlated with WOMAC functional score at 12 months in three studies (r = 0.20 p < 0.05, R = 0.317 p = 0.001, and correlation coefficient 0.197 p = 0.005). TSK score significantly correlated with mean active range of motion (ROM) at six months (105.33 (SD = 12.34) vs 85.53 (SD = 14.77) p = 0.000) post-operation. Three post-operative interventions improved TSK score vs control following TKR: a home-based functional exercise programme (TSK -14.30 (SD = 0.80) vs -2.10 (SD = 0.80) p < 0.001)), an outpatient CBT programme (TSK 27.76 (SD = 4.56) vs 36.54 (SD = 3.58), and video-based psychological treatment (TSK 24 (SD = 5) vs 29 (SD = 5) p < 0.01). Conclusions Kinesiophobia negatively affects functional outcomes up until one year post-operatively, while active ROM is reduced up to six months post procedure. Post-operative functional and psychological interventions can improve kinesiophobia following TKR.

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