Post-operative limb position can influence blood loss and range of motion after total knee arthroplasty: a systematic review

Faldini, Cesare; Traina, Francesco; Fine, Marcello De; Pedrini, Marco; Sambri, Andrea

doi:10.1007/s00167-013-2732-4

Cited by 24 publications

(21 citation statements)

References 33 publications

(148 reference statements)

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“…The main goals of TKA are to provide pain relief, joint stability and satisfactory ROM. Early restoration of a satisfactory knee ROM can improve the patient’s condition at discharge, and a decreased transfusion rate could make the procedure cheaper 37. The reported findings on the impact of ERAS demonstrate how improvements can be achieved using a comprehensive approach to perioperative care 38…”

Section: Discussionmentioning

confidence: 83%

Impact of enhanced recovery after surgery on postoperative recovery after joint arthroplasty: results from a systematic review and meta-analysis

Deng

Peng

et al. 2018

Postgraduate Medical Journal

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Study designSystematic review with meta-analysis.ObjectivesTo evaluate the effects of enhanced recovery after surgery (ERAS) on the postoperative recovery of patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA).MethodsThe PubMed, Embase, Cochrane and ISI Web of Science databases were searched to identify literature including randomised controlled trials (RCTs), cohort studies and case–control studies through 2 May 2018. The analysed outcomes were mortality rate, transfusion rate, range of motion (ROM), 30-day readmission rate, postoperative complication rate and in-hospital length of stay (LOS).ResultsA total of 25 studies involving 16 699 patients met the inclusion criteria and were included in the meta-analysis. Compared with conventional care, ERAS was associated with a significant decrease in mortality rate (relative risk (RR) 0.48, 95% CI 0.27 to 0.85), transfusion rate (RR 0.43, 95% CI 0.37 to 0.51), complication rate (RR 0.74, 95% CI 0.62 to 0.87) and LOS (mean difference (MD) −2.03, 95% CI −2.64 to −1.42) among all included trials. However, no significant difference was found in ROM (MD 7.53, 95% CI −2.16 to 17.23) and 30-day readmission rate (RR 0.86, 95% CI 0.56 to 1.30). There was no significant difference in complications of TKA (RR 0.84, 95% CI 0.34 to 2.06) and transfusion rate in RCTs (RR 0.66, 95% CI 0.15 to 2.88) between the ERAS group and the control group.ConclusionsThis meta-analysis showed that ERAS significantly reduced the mortality rate, transfusion rate, incidence of complications and LOS of patients undergoing TKA or THA. However, ERAS did not show a significant impact on ROM and 30-day readmission rate. Complications after hip replacement are less than those of knee replacement, and the young patients recover better.Level of evidenceLevel 1.

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Section: Discussionmentioning

confidence: 83%

Impact of enhanced recovery after surgery on postoperative recovery after joint arthroplasty: results from a systematic review and meta-analysis

Deng

Peng

et al. 2018

Postgraduate Medical Journal

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“…Compared with a previous systematic review by Faldini [29], there are several improvements in our study. First, this is the first meta-analysis to have quantified the results for the topic.…”

Section: Discussionmentioning

confidence: 85%

Impact of flexion versus extension of knee position on outcomes after total knee arthroplasty: a meta-analysis

Jiang

Lou

Qian

et al. 2016

Arch Orthop Trauma Surg

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IntroductionControversy still exists regarding positioning of the knee in flexion or in extension after total knee arthroplasty (TKA) impacts treatment outcomes. In this meta-analysis, we evaluated if a postoperative knee position regime could positively affect the rehabilitation.MethodsA comprehensive search for randomized controlled trials (RCTs) assessing the effect of knee positioning after TKA was conducted. The outcomes of interest were blood loss and range of motion (ROM); total calculated blood loss (CBL), drainage volume, hidden blood loss (HBL), decline of hemoglobin level and requirement for blood transfusion.ResultsTen RCTs involving 962 knees were eligible for meta-analysis. Positioning the knee in flexion after TKA was significantly associated with lesser CBL (P < 0.00001), less HBL (P < 0.00001) and decreased requirement for blood transfusion (P = 0.06). On subgroup analyses, the flexion group was found to have significantly less decrease in hemoglobin level 48 h to 6 days after surgery (P = 0.003), while no significant difference was noted at 24 h after surgery (P = 0.29). Further,a superior ROM was observed in flexion group (5–7 days after surgery) (P = 0.002), while there was no significant difference at 6 weeks. No significant inter-group difference in wound drainage was observed at 24 h after surgery.ConclusionPositioning the knee in flexion in the early postoperative stage was associated with significantly lesser CBL, lesser HBL, decreased requirement for blood transfusion and better ROM at least in the early postoperative period, which may contribute to early rehabilitation. However, no significant difference was found in ROM at 6 weeks.

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“…Postoperative factors include postoperative rehabilitation, pain management, and arthrofibrosis. 2,3,7,8 The role of knee position during surgical closing, one of the intraoperative factors, is still controversial. 1,16 King et al mentioned that closing the knee in 120°flexion prevents extensor mechanism overtension and leads to increased postoperative ROM.…”

Section: Total Workmentioning

confidence: 99%

The Role of Surgical Closure Position in Total Knee Arthroplasty: Flexion versus Extension—A Randomized Prospective Study

et al. 2018

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We aimed to investigate the effect of the knee position during the surgical closure on isokinetic muscle strength, clinical score, and range of motion in total knee arthroplasty. Seventy-five eligible patients were enrolled in the study and randomly divided into two groups; wound closure was performed with the knee flexed at 90° in group 1 and knee extended in group 2. All the surgeries were performed by the same surgeon and by the same prosthesis type. All the patients received the same rehabilitation program postoperatively. The primary outcomes were the knee flexion degrees and the American Knee Society Score values at preoperative and postoperative 6 weeks, 3, and 6 months. The secondary outcome was the isokinetic muscle strength measurements of both knees before the surgery and after 6 months. There were no significant differences in the American Knee Society Scores and knee flexion degrees between the flexion and extension groups. However, a significant decrease was found in the extensor muscle strength in the extension group after 6 months of the surgery. The findings of our study are that the closing of the knee in flexion or extension does not affect the postoperative knee flexion degrees and scores in total knee arthroplasty. However, quadriceps strength recovers early if the knee closure is performed in flexion position.

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Post-operative limb position can influence blood loss and range of motion after total knee arthroplasty: a systematic review

Abstract: Based on the studies undertaken to date, a 48-72 h post-operative knee flexion protocol should be implemented as an easy and inexpensive method of reducing blood loss and increasing ROM following TKA. Shorter flexion regimes failed to influence these parameters.

Cited by 24 publications

References 33 publications

Impact of enhanced recovery after surgery on postoperative recovery after joint arthroplasty: results from a systematic review and meta-analysis

Impact of enhanced recovery after surgery on postoperative recovery after joint arthroplasty: results from a systematic review and meta-analysis

Impact of flexion versus extension of knee position on outcomes after total knee arthroplasty: a meta-analysis

The Role of Surgical Closure Position in Total Knee Arthroplasty: Flexion versus Extension—A Randomized Prospective Study

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