Efficacy and safety of limb position on blood loss and range of motion after total knee arthroplasty without tourniquet: A randomized clinical trial.

Abstract

BACKGROUND:

The purpose of this study was to investigate the effect of postoperative limb position on blood loss and knee function after primary total knee arthroplasty without tourniquet.

MATERIAL AND METHODS:

One hundred patients were randomly assigned into 2 groups: Group A was given a knee flexion position at 60° for 24 h after surgery but without the tourniquet use. Patients in group B was received the tourniquet use the same flexion position as the Group A. All patients received intravenous (IV) tranexamic acid (TXA) 15 mg/kg before skin incision and another 1 g of IV-TXA after 3 h.

RESULTS:

The total blood loss was similar in the 2 groups. Group A had significantly less hidden blood loss and drainage volume (P = 0.023, P < 0.001), and higher intraoperative blood loss than the Group B (P < 0.001). The visual analog scale and knee circumference in Group A were lower than the Group B on postoperative days 1, 3 and 5. The range of motion was also lowering in Group A than the Group B on postoperative days 1, 3, 5 and at the 1 month. No significant differences (P > 0.05) were observed between the 2 groups regarding maximum hemoglobin drop, transfusion rate, postoperative hospital stay, DVT and/or PE, and wound-related complications.

CONCLUSION:

Based on the current evidence, patients treated with postoperative limb positions without a tourniquet can effectively reduce hidden blood loss and drainage volume, as well as better early clinical benefits than those treated with a tourniquet.

LEVEL OF EVIDENCE:

Therapeutic Level I.

• Authors: Yuangang Wu, Xiaoxi Lu, Yimei Ma, Yi Zeng, Huazhang Xiong, Xianchao Bao, Bin Shen
• Journal: International journal of surgery (London, England) (Int J Surg) Vol. 60 Pg. 182-187 (Dec 2018) ISSN: 1743-9159 [Electronic] United States
• PMID: 30468901 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2018. Published by Elsevier Ltd.

Topics

• Aged
• Arthroplasty, Replacement, Knee (adverse effects)
• Blood Loss, Surgical (prevention & control)
• Drainage
• Extremities (surgery)
• Female
• Humans
• Knee Joint (physiopathology)
• Male
• Middle Aged
• Patient Positioning
• Postoperative Period
• Range of Motion, Articular
• Tourniquets