A new improvement: subperiosteal cocktail application to effectively reduce pain and blood loss after total knee arthroplasty

Yanxin Wang,Aiguo Zhou

doi:10.1186/s13018-020-1563-5

Abstract

BackgroundPain and blood loss after total knee arthroplasty (TKA) are unsolved clinical problems. Some studies reported that periarticular cocktail injection can effectively reduce pain and blood loss. However, there was no gold standard about the cocktail ingredient and injection location. More osteotomy and less soft tissue release in TKA with mild deformity; besides, plenty of nerves and blood vessels are contained in the periosteums and bone marrow. In this study, we aimed to detect the clinical results of subperiosteal cocktail application in TKA.MethodsTwo groups were included according to the different injection location in our study. In group 1, cocktails were injected into the muscles, tendons, suprapatellar bursa, and subpatellar bursa surrounding knee joint. In group 2, cocktail injection was performed under the periosteum of the distal femur and proximal tibia. Our primary outcomes were visual analogue scale (VAS) and hemoglobin (Hb), and the secondary outcomes were wound healing, infection, deep vein thrombosis (DVT), operation time, and hospitalization.ResultsAt the first operative day, the mean (standard deviation) VAS score in a state of static was lower in group 2 compared with group 1 (0.98 ± 0.27 in group 1 and 0.86 ± 0.60 in group 2, p < 0.05). In the state of flexion and extension, the mean (standard deviation) VAS was 1.61 ± 0.66 in group 1 and 1.10 ± 0.57 in group 2 (p < 0.05). The mean (standard deviation) blood loss was higher in group 1 than in group 2 at the first postoperative day (440.19 (167.68) ml in group 1 and 333.67 (205.99) ml in group 2, p < 0.05). At the third day after surgery, the mean (standard deviation) blood loss was 686.44 (140.29) ml in group 1 and 609.19 (260.30) ml in group 2, and there was significant difference between these two groups (p < 0.05).ConclusionsWe concluded that subperiosteal cocktail injection can significantly reduce pain and blood loss compared with periarticular cocktail injection after TKA.

Highlights

Pain and blood loss after total knee arthroplasty (TKA) were still two of hot topic clinical problems
Cocktail injection is popular with surgeons which is injected into the tissues surrounding knee joint, such as the muscles, tendons, suprapatellar bursa, and subpatellar bursa
All patients were divided into two groups; there were 82 patients in Surgical technique and postoperative care Intravenous antibiotics were given before surgery to prevent infection, and 1.5 g of tranexamic acid (TXA) was given to reduce perioperative blood loss

Summary

Introduction

Pain and blood loss after total knee arthroplasty (TKA) were still two of hot topic clinical problems. Continuous epidural infiltration of the femoral or sciatic nerve [2] has been used to reduce pain in TKA. These methods have been associated with nerve injury, diminished muscle control, bleeding, and infection [2,3,4,5,6]. There was no gold standard about the cocktail ingredient and injection location, a recent study showed that altering. Pain and blood loss after total knee arthroplasty (TKA) are unsolved clinical problems. We aimed to detect the clinical results of subperiosteal cocktail application in TKA

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Methods

Results

Conclusion