Postoperative blood loss management in total knee arthroplasty: a comparison of four different methods

Mađarević, Tomislav; Tudor, Anton; Šestan, Branko; Šantić, Veljko; Gulan, Gordan; Prpić, Tomislav; Ružić, Lana

doi:10.1007/s00167-010-1309-8

Cited by 21 publications

(38 citation statements)

References 16 publications

(24 reference statements)

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“…Johnson has reported that knee flexion following TKA might increase wound complications by lowering oxygen tension in the wound edges [28]. Eight of the included studies [11, 14, 16, 18–22] mentioned these complications while the remaining two failed to do so [15, 17], and our study did not find any difference in wound complications between the two groups (Table 3). …”

Section: Discussionsupporting

confidence: 44%

“…Eight of the included studies [11, 14, 16, 18–22] mentioned these complications while the remaining two failed to do so [15, 17], and our study did not find any difference in wound complications between the two groups (Table 3). …”

Section: Discussionmentioning

confidence: 54%

“…Randomization was done using the random number list in four studies [11, 17–22]; the closing envelope technique [14, 16] and calendar randomization [15] were used in the remaining three. The detailed risk of bias in methodological quality of included studies is elaborated in Fig.…”

Section: Resultsmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 44%

Section: Discussionmentioning

confidence: 54%

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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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“…49,51 It may also increase wound complications by reducing oxygen tension at the wound edges without a substantial benefit toward prevention of blood loss. 52,53 Li et al in a prospective, randomized study of 110 patients undergoing TKA compared the efficacy of limb positioning in 30 degrees of knee flexion versus knee extension on blood loss and range of motion. 49 The authors found significantly lower hidden blood loss (566 vs. 611 mL; p < 0.05), smaller increases in limb circumference (2.1 vs. 4.8%; p < 0.05), and reduced areas of skin ecchymosis (0.6 vs. 1.3%; p < 0.001) in the knee flexion compared with the extension groups.…”

Section: Postoperative Limb Positioningmentioning

confidence: 99%

“…However, other authors have found no substantial improvements in blood savings with the use of compressive dressings. 53,57 In a prospective, randomized, controlled trial of 147 patients undergoing TKA, Madarevic et al evaluated the efficacy of a combination of limb positioning and compression dressings (flexion only; flexion and compression; compression only; and controls) on postoperative blood loss prevention. 53 The authors found no significant difference in the hemoglobin loss, hematocrit reduction, external drainage, and duration of hospitalization between the four cohorts (p > 0.05).…”

Section: Compression Dressingsmentioning

confidence: 99%

Postoperative Blood Loss Prevention in Total Knee Arthroplasty

et al. 2013

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Blood loss is a serious concern during lower extremity total joint arthroplasty with the estimated reduction in hemoglobin concentration known to vary between 2 and 4 g/dL after total knee arthroplasty (TKA). Allogeneic transfusions are commonly used to treat the acute blood loss and postoperative anemia to diminish the potential cardiovascular risks in up to 50% of such cases with a high volume of blood loss. However, these transfusions are associated with the risks of immunologic reactions, immunosuppression, and infection transmission. Multiple blood-saving strategies have been developed to minimize blood loss, to reduce transfusion rates, to decrease complications, and to improve outcomes in the postoperative period. Currently, there are no clear guidelines on the blood management strategies adopted to lessen the blood loss associated with TKA. The aim of this study was to review the literature and provide a broad summary of the efficacy and complications associated with several blood-saving measures that are currently used in the postoperative period. Evidence suggests that simple techniques such as limb elevation, cryotherapy, compression dressings, and drain clamping may reduce external drainage, however, whether these techniques lead to less allogeneic transfusions is currently debatable. Further research on using a combination of these strategies and their cost-effectiveness are needed.

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

Faldini

Traina

Fine

et al. 2013

Knee Surg Sports Traumatol Arthrosc

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Postoperative blood loss management in total knee arthroplasty: a comparison of four different methods

Abstract: No significant differences among the four proposed blood saving methods were determined.

Cited by 21 publications

References 16 publications

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

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

Postoperative Blood Loss Prevention in Total Knee Arthroplasty

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

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