Effect of different postoperative limb positions on blood loss and range of motion in total knee arthroplasty: An updated meta-analysis of randomized controlled trials

Wu, Yuangang; Yang, Ti-min; Zeng, Yi; Si, Haibo; Li, Canfeng; Shen, Bin

doi:10.1016/j.ijsu.2016.11.135

Cited by 20 publications

(18 citation statements)

References 28 publications

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“…Different knee flexion positions ( e.g ., hip elevation by 60° combined with 60° knee flexion) have been reported to have promising results with respect to reducing perioperative blood loss[157-159]. Based on these studies, we conclude that post-operative knee flexion is an easy, inexpensive and effective method in blood loss reduction.…”

Section: Post-operativementioning

confidence: 69%

Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

Themistoklis¹,

Vogiatzaki²,

Kazakos³

et al. 2017

WJO

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Total knee replacement (TKR) is one of the most common surgeries over the last decade. Patients undergoing TKR are at high risk for postoperative anemia and furthermore for allogeneic blood transfusions (ABT). Complications associated with ABT including chills, rigor, fever, dyspnea, light-headedness should be early recognized in order to lead to a better prognosis. Therefore, perioperative blood management program should be adopted with main aim to reduce the risk of blood transfusion while maximizing hemoglobin simultaneously. Many blood conservation strategies have been attempted including preoperative autologous blood donation, acute normovolemic haemodilution, autologous blood transfusion, intraoperative cell saver, drain clamping, pneumatic tourniquet application, and the use of tranexamic acid. For practical and clinical reasons we will try to classify these strategies in three main stages/pillars: Pre-operative optimization, intra-operative and post-operative protocols. The aim of this work is review the strategies currently in use and reports our experience regarding the perioperative blood management strategies in TKR.

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Section: Post-operativementioning

confidence: 69%

Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

Themistoklis¹,

Vogiatzaki²,

Kazakos³

et al. 2017

WJO

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“…Our meta-analysis has several advantages compared with the meta-analysis previously published by Faldini et al [31], Fu et al [7], Jiang et al [30], and Wu et al [32]. First, our study included one recent high-quality RCT by Zeng et al [26] and six RCTs [34–39] written in Chinese excluded by previous reviews, which would have reduced statistical bias and publication bias.…”

Section: Discussionmentioning

confidence: 96%

“…Mild flexion may be less effective for blood loss reduction because it leads to lower compression on the blood vessel with lower effect on peripheral blood circulation [25]. However, Wu et al [32] performed a meta-analysis of nine RCTs to compare the effectiveness of different limb positions in primary TKA and found that knee mild flexion (< 60°) protocol is significantly beneficial with hidden blood loss after TKA compared with knee high flexion (≥ 60°); knee high flexion (≥ 60°) protocol is superior to mild flexion (< 60°) protocol in reducing blood transfusion requirements and improving ROM following TKA. De Fine et al [33] conducted a randomized controlled trial of 62 patients to understand the optimal degree of flexion required to improve functional outcomes and found that no significant differences were found between the high flexion (70°) and mild flexion (30°) group in terms of blood loss, transfusion requirements, and ROM after TKA.…”

Section: Discussionmentioning

confidence: 99%

“…However, recently, three high-quality randomized controlled trials (RCTs) reported knee flexion for 6–24 h could significantly reduce blood loss and the need for blood transfusion compared with knee extension following TKA [20, 25, 26]. A recent updated meta-analysis of RCTs has demonstrated that compared with knee high flexion (≥ 60°), mild flexion (<60°) positioning is significantly beneficial with hidden blood loss after TKA and high flexion (≥60°) positioning is superior to mild flexion (< 60°) positioning in reducing blood transfusion requirements and improving ROM following TKA [32], but the study did not perform subgroup analysis based on the time (6–72 h) of knee flexion, which may lower the accuracy of conclusions. Although the results of new RCTs by De Fine et al [33] suggested that no significant differences related to blood loss reduction, blood transfusion diminution, and ROM improvement after TKA were found between the high flexion (70°) and mild flexion (30°) group, this study lacked a control group of knee extension and sufficient sample size.…”

Section: Introductionmentioning

confidence: 99%

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An updated meta-analysis evaluating limb management after total knee arthroplasty—what is the optimal method?

Wang

et al. 2019

J Orthop Surg Res

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Purpose Postoperative knee flexion protocol has been widely recognized as a highly attractive, simple, and cost-effective tactic to improve patient’s outcomes after primary total knee arthroplasty (TKA). However, optimal knee position and duration of knee flexion are still controversial. The purpose of this meta-analysis was to compare the effectiveness of different postoperative knee flexion protocols, as an aid to find out optimal limb management strategy following TKA. Methods We conducted a meta-analysis to identify the available and relevant randomized controlled trials (RCTs) with regard to the influence of different postoperative knee positions on clinical outcomes after primary TKA in electronic databases, including PubMed, EMBASE, the Cochrane Library, Web of Science, CNKI, Wanfang Med Online, and VIP, up to May 2018. In this meta-analysis, three major subgroups based on diverse postoperative knee flexion protocols were considered: long-term (≥ 24 h) high flexion (> 30°), short term (< 24 h) high flexion (> 30°), and long-term (≥ 24 h) mild flexion (≤ 30°). The statistical analysis was performed using the Review Manager (RevMan) version 5.3 software. Results A total of 16 trials were finally included in this meta-analysis. The result of subgroup analysis indicated that keeping the knee in high flexion (> 30°) postoperatively for a long time (≥ 24 h) significantly reduced total blood loss ( P < 0.00001), hidden blood loss ( P < 0.00001), and transfusion requirements ( P = 0.003) and led to a significant improvement in range of motion (ROM) at 1 week after operation ( P < 0.00001); keeping the knee in high flexion (> 30°) postoperatively for a short time (< 24 h) significantly reduced total blood loss ( P = 0.006) and hidden blood loss ( P < 0.00001) but not significantly improved ROM at 1 week after operation ( P = 0.34) and reduced transfusion requirements ( P = 0.62); and keeping the knee in mild flexion (≤ 30°) postoperatively for a long time (≥ 24 h) significantly reduced total blood loss ( P = 0.02) and transfusion requirements ( P = 0.02) and improved ROM at 1 week after operation ( P < 0.00001) but not significantly reduced hidden blood loss ( P = 0.11). Furthermore, there was no significant difference with respect to the rates of wound-related infection and DVT between the three knee flexion subgroups. Conclusions This meta-analysis showed that the long-term (≥ 24 h) high flexion (> 30°) protocol could be an optimal limb management to reduce blood loss and blood transfusion requirements and facilitate early postoperative rehabilitation exercises in patients after primary TKA w...

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“…Простой, экономичной и эффективной мерой для снижения кровопотери при ЭКС является сгибание нижней конечности в коленном суставе в первые 48-72 ч послеоперационного периода [55]. Предполагается, что угол сгибания 60° и более в тазобедренном и коленном суставах обеспечивает наилучшие результаты [56]. В многочисленных обзорах подтверждено, что поддержание коленного сустава в положении сгибания ведет к уменьшению скрытой и общей кровопотери, увеличению объема движений и не связано с повышенным риском тромбоза глубоких вен и раневой инфекции [55,56].…”

Section: послеоперационное положение нижней конечностиunclassified

Patient blood management in orthopedic surgery

Borisov¹,

Киров²

2019

Anesteziologiya I Reanimatologiya

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Эндопротезирование улучшает качество жизни пациентов с конечной стадией дегенеративных заболеваний суставов нижних конечностей, и количество таких операций неуклонно растет. Эндопротезирование крупных суставов сопровождается большой кровопотерей, высокой частотой послеоперационной анемии и гемотрансфузий. Анемия и аллогенная гемотрансфузия увеличивают послеоперационную заболеваемость и летальность. Минимизировать потребность в препаратах донорской крови и в то же время предотвратить развитие анемии позволяет менеджмент крови пациента (МКП)-основанный на доказательствах мультидисциплинарный, мультимодальный подход к оптимизации лечения пациентов, потенциально нуждающихся в аллогенной трансфузии. В обзоре приведен анализ результатов исследований по проблеме эффективности компонентов МКП в ортопедии при эндопротезировании крупных суставов. Отмечено, что имеется доказательная база эффективности выявления и лечения предоперационной анемии, периоперационного использования транексамовой кислоты и препаратов железа для внутривенного введения, ограничительного подхода к гемотрансфузии в снижении частоты анемии и аллогенной гемотрансфузии. Эритропоэтин и методы аутогемотрансфузии не подходят для рутинного применения, но могут быть полезны в отдельных случаях. Влияние многих методов на исход требует дальнейшего изучения.

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Effect of different postoperative limb positions on blood loss and range of motion in total knee arthroplasty: An updated meta-analysis of randomized controlled trials

Cited by 20 publications

References 28 publications

Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

An updated meta-analysis evaluating limb management after total knee arthroplasty—what is the optimal method?

Patient blood management in orthopedic surgery

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