scholarly journals After Total Knee Arthroplasty Different Knee Position Bring Distinct Effects-a Prospective Study of One Hundred Patients

2021 ◽  
Author(s):  
ke zheng ◽  
Wen-xiang Liu ◽  
Jie-bin Zhang
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Functional Recovery ◽  
Knee Arthroplasty ◽  
Randomized Study ◽  
Osteoarthritis Of The Knee ◽  
Total Blood ◽  
Number Of Patients ◽  
Extension Group ◽  
Total Knee

Abstract Background Following total knee arthroplasty (TKA) blood loss is a major factor influencing functional recovery and quality of life in patients. The aim of this study was to determine the effect of postoperative leg position on blood loss and functional recovery after TKA.Methods One hundred consecutive patients were enrolled in this prospective randomized study, which with degenerative osteoarthritis of the knee. An equal number of patients were randomly allocated to either flexion or extension groups. In the flexion group, the affected leg was elevated 45° at the hip and with 45° of flexion at the knee, while patients in the extension group had the knee extended fully. Primary outcomes were calculated total blood loss (CBL), hidden blood loss(HBL), intraoperative blood loss(IBL),haemoglobin(HB) level and haematocrit(HCT).Results CBL, HBL, postoperative levels of HB and HCT, drop level of HB and HCT between the two groups after 72 hours were significantly different, with patients in the flexion group experiencing lower blood loss than those in the extension group (P < 0.05).However, there no difference between groups in the postoperative levels of HB and HCT, drop level of HB and HCT at 24 hours. Even though after 1 week range of motion (ROM) was statistical difference in groups, but after 6-week rehabilitation, patients from both groups attained a similar ROM in the knee. Conclusions The results of this study definite that after TKA execute the protocol，maintaining a position with the hip 45°flexion and the knee flexed at 45° prolong 48 hours, is an effective method for reducing blood loss and increasing functional ROM.

scholarly journals Effect of Tourniquet use on Blood Loss, Pain, Functional Recovery, and Complications in Robot-assisted Total Knee Arthroplasty: A Prospective, Double-blinded, Randomized Controlled Trial

2021 ◽  
Author(s):  
Yahao Lai ◽  
Hong Xu ◽  
Qiang Su ◽  
Xufeng Wan ◽  
Mingcheng Yuan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Blood Loss ◽  
Range Of Motion ◽  
Functional Recovery ◽  
Knee Arthroplasty ◽  
Total Blood Loss ◽  
Robot Assisted ◽  
Total Blood ◽  
Total Knee

Abstract Background: Robot-assisted total knee arthroplasty (TKA) has been largely studied to confirm its advantages in terms of accurate component positioning, microembolus formation, less blood loss and so on, but is currently usually performed under tourniquet due to its longer operative time than conventional TKA. The aim of this study was to estimate the effects of tourniquet use in robot-assisted TKA on blood loss, pain, functional recovery, and complications.Methods: Patients scheduled for robot-assisted TKA were prospectively randomized into a tourniquet or non-tourniquet group (each n = 14). The primary outcome measure was blood loss. The secondary outcome measures were operation time; visual analog scale (VAS) pain scores; time to achieve the first straight-leg raise; swelling of the thigh, knee, and calf; range of motion; Hospital for Special Surgery score; length of stay; and postoperative complications. Results: There was no significant difference in total blood loss between the tourniquet and non-tourniquet groups (738.57 ± 276.158 vs. 866.85 ± 243.422 ml, P = 0.061). The tourniquet group showed significantly lower intraoperative blood loss (P < 0.001), but higher hidden blood loss (P = 0.002). The non-tourniquet group showed better knee range of motion on POD 1-3 (all P < 0.001), less thigh swelling on PODs 2 and 3 (P < 0.05), earlier straight-leg raising (P = 0.044), and shorter length of stay (P = 0.044). Thigh pain VAS score at 1 month after surgery was significantly greater in the tourniquet group (P < 0.001), as was knee pain during activity and at rest on PODs 2-3 (all P < 0.05). The tourniquet group also showed a significantly higher rate of tension blisters (28.8% vs. 7.1%, P = 0.038). Conclusions: Tourniquet use during robot-assisted TKA dose not reduce total blood loss and it appears to increase postoperative pain, aggravate muscle injury, and prolong postoperative recovery.Trial registration: ChiCTR, ChiCTR2100041800. Registered 5 January 2021, http://www.chictr.org.cn/index.aspx

scholarly journals Use of tranexamic acid in total knee arthroplasty

Joints ◽  
2016 ◽  
Vol 04 (04) ◽  
pp. 202-213 ◽  
Author(s):  
Francesco Marra ◽  
Federica Rosso ◽  
Matteo Bruzzone ◽  
Davide Bonasia ◽  
Federico Dettoni ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Demographic Data ◽  
Level Of Evidence ◽  
Total Blood ◽  
Prospective Comparative Study ◽  
Total Knee ◽  
Student’S T

Purpose: different strategies have been developed to reduce blood loss in total knee arthroplasty (TKA). The efficacy of both systemic and local tranexamic acid (TXA) administration is demonstrated in the literature. The aim of the present study was to compare the efficacy of systemic, local and combined (systemic + local) administration of TXA in reducing blood loss after TKA. Methods: we enrolled all patients submitted to a primary TKA in our department between November 2014 and August 2015. They were divided into three groups corresponding to the method of TXA administration used: intravenous (IV), intra-articular (IA), and a combination of the two. Demographic data, as well as preoperative hemoglobin and platelet levels, were collected. The primary outcome was the maximum hemoglobin loss, while the secondary outcomes were the amount of blood in the drain (cc/hour) and the rate of transfusions; postoperative pain was also assessed. Student’s t-test or a χ2 test was used to evaluate between-group differences, using p<0.05 as the cut-off for statistically significant differences. Results: the sample comprised 34 patients: IV, 10 cases; IA, 15 cases, and combined (IV + IA), 9 cases. The average age of the patients was 71.1±6.4 years. No significant differences in the outcome measures were found between the groups, with the exception of a significantly lower maximum hemoglobin loss in the combined versus the IV group (p=0.02). There were no differences between the groups in the amount of blood in the drain or the rate of transfusions. Conclusions: the data from this preliminary study, as well as data from the literature, confirm that TXA administration is safe and effective in reducing total blood loss in TKA, and no administration protocol seems to be superior to the others. Level of evidence: Level II, prospective comparative study.

scholarly journals Intravenous and subsequent long-term oral tranexamic acid in enhanced-recovery primary total knee arthroplasty without the application of a tourniquet: a randomized placebo-controlled trial

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Hao-Yang Wang ◽  
Liu Wang ◽  
Ze-Yu Luo ◽  
Duan Wang ◽  
Xin Tang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Total Blood ◽  
Significant Difference ◽  
Group A ◽  
Total Knee ◽  
Group B

Abstract Background To assess the efficacy and safety of intravenous and subsequent long-term oral tranexamic acid (TXA) following total knee arthroplasty (TKA) without a tourniquet. Methods In this double-blinded trial, 118 patients undergoing primary TKA were randomized into two groups: the patients in group A received intravenous TXA at 20-mg/kg 10 min before the surgery and 3 h postoperatively, and then oral 1 g TXA from postoperative day (POD) 1 to POD 14, and the patients in group B received intravenous TXA at 20-mg/kg 10 min before surgery and 3 h postoperatively, and then oral 1 g placebo from postoperative day (POD) 1 to POD 14. The primary outcome was total blood loss. Secondary outcomes included ecchymosis area and morbidity, postoperative transfusion, postoperative laboratory values, postoperative knee function and length of hospital stay. Complications, and patient satisfaction were also recorded. Results The mean total blood loss was lower in Group A than in Group B (671.7 ml vs 915.8 ml, P = 0.001). There was no significant difference in the transfusion rate between the two groups. Group A had a higher hemoglobin than Group B on POD 3 (106.0 g/L vs 99.7 g/L, P = 0.001). However, no significant difference was found for Hb or hematocrit on POD 1 or POD 14 between the two groups. Patients in Group A had less ecchymosis morbidity (7 vs 38, P = 0.001), smaller ecchymosis area (1.6 vs 3.0, P = 0.001) than Group B. The blood coagulation level as measured by fibrinolysis (D-Dimer) was lower in Group A than in Group B on POD 1 and POD 3 (4.6 mg/L vs. 8.4 mg/L, respectively, P = 0.001; 1.5 mg/L vs. 3.3 mg/L, respectively, P = 0.001). However, there was no significant difference on POD 14, and the fibrin degradation products showed the same trend. Patients in Group A had less swelling than those in Group B on POD 3 and POD 14. The circumference of the knee was 43.1 cm vs. 46.1 cm (POD 3, P = 0.001) and 41.4 cm vs. 44.9 cm (POD 14, P = 0.001) in Group A vs Group B, respectively. Nevertheless, the circumference of the knee in the two groups was similar on POD 1 and POD 3 M. No significant differences were identified in knee function, pain score, or hospital stay. No significant differences were identified in thromboembolic complications, infection, hematoma, wound healing and patients satisfaction between the two groups. Conclusion Intravenous and subsequent long-term oral TXA produced less blood loss and less swelling and ecchymosis compared with short-term TXA without increasing the risk of complications. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-IPR-17012264).

scholarly journals Hemostatic effect of tourniquet combined with tranexamic acid in total knee arthroplasty: a network meta-analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yimin Zhang ◽  
Bao Lang ◽  
Guifeng Zhao ◽  
Fengming Wang
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Total Blood Loss ◽  
Total Blood ◽  
Study Results ◽  
Total Knee

Abstract Background There are various techniques to reduce blood loss in total knee arthroplasty (TKA), including the use of a tourniquet and tranexamic acid (TXA). In this study, we studied the combined effect of TXA with a tourniquet on blood loss in the setting of primary TKA. Methods Randomized controlled trials (RCTs) of nine treatment methods were included (placebo, intravenous [i.v.] TXA, topical TXA, i.v.-combined topical TXA, oral TXA, placebo + tourniquet, i.v. TXA +tourniquet, topical TXA + tourniquet, and i.v.-combined topical TXA + tourniquet). The patients were divided into eight groups according to the different treatment strategies, with 30 cases per group. The differences in the total blood volume, the number of patients transfused, the hemoglobin before and after the operation, and complications after the operation were compared. Results Totally 15 RCTs meeting our inclusion criteria were collected in this study. Compared with the placebo + tourniquet group, the i.v. TXA + tourniquet group displayed lower hemoglobin reduction value, pulmonary embolism (PE) incidence, total blood loss, and blood transfusion risk; the topical TXA + tourniquet group showed reduced PE incidence, total blood loss, and blood transfusion risk, and the i.v.-combined topical TXA and i.v.-combined topical TXA + tourniquet groups showed decreased total blood loss and lower blood transfusion risk. Retrospective clinical study results also demonstrated that the efficacy of i.v.-combined topical TXA was the best. Conclusions Our meta-analysis indicates that i.v.-combined topical TXA provides a low total blood loss without increasing the blood transfusion risk in patients undergoing total knee replacement surgery.

One step closer to sparing total blood loss and transfusion rate in total knee arthroplasty: a meta-analysis of different methods of tranexamic acid administration

2015 ◽  
Vol 135 (4) ◽  
pp. 573-588 ◽  
Author(s):  
Hamidreza Shemshaki ◽  
Sayed Mohammad Amin Nourian ◽  
Niloofaralsadat Nourian ◽  
Masoudhatef Dehghani ◽  
Masoud Mokhtari ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Transfusion Rate ◽  
Total Blood ◽  
One Step ◽  
Total Knee ◽  
Acid Administration

scholarly journals Total blood loss in total knee arthroplasty. A comparison of drain-clamped and non drain-clamped operations.

1990 ◽  
Vol 38 (4) ◽  
pp. 1739-1742 ◽  
Author(s):  
Harumichi Senda ◽  
Kazutoshi Nomura ◽  
Mitsuyoshi Oda ◽  
Mako Hirano ◽  
Masaaki Sakisaka ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Total Blood Loss ◽  
Total Blood ◽  
Total Knee

scholarly journals Comparative analysis of hidden blood loss in total knee arthroplasty

2021 ◽  
Vol 13 (2) ◽  
Author(s):  
Antonio Gavrilovski ◽  
Ilir Shabani ◽  
Vilijam Velkovski ◽  
Teodora Todorova ◽  
Shaban Memeti
Keyword(s):  
Total Knee Arthroplasty ◽  
Comparative Analysis ◽  
Blood Loss ◽  
Knee Osteoarthritis ◽  
Knee Arthroplasty ◽  
Late Stage ◽  
Influential Factors ◽  
Total Blood ◽  
Hidden Blood Loss ◽  
Total Knee

The aim of the study was to investigate the influential factors for hidden blood loss after a total knee arthroplasty and their relationship with the total blood loss. Total knee arthroplasty (TKA) is a crucial treatment of late-stage knee osteoarthritis. Measured blood loss is significantly inconsistent with the hemoglobin (HB) drop postoperatively. Fifty-four patients, 20 males and 34 females, were retrospectively analyzed. The preoperative blood loss and therefore the hidden blood loss following TKA were calculated by the Gross formula. The typical perioperative blood loss was found to be 780±220 ml and therefore the average hidden blood loss was 280±180 ml. No significant differences were found in hidden blood loss for males compared to females. Hidden blood loss may not be reduced by hemostasis during operation with a deflated tourniquet.

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