Abstract
ObjectiveBlood loss following total knee arthroplasty is a serious side-effect of surgery and impacts on patient recovery and quality of life. The aim of this study was to assess the effect of postoperative knee position during recovery on blood loss and range of motion.MethodsOne hundred consecutive patients, with stage III or IV degenerative osteoarthritis, were enrolled in the study and randomized equally between two treatment groups: flexion and extension. In the flexion group, the affected leg was elevated postoperatively by 45° at the hip, with 45° flexion at the knee, while patients in the extension group had the knee extended fully. Blood loss, pre- and postoperative hemoglobin levels, and range of motion were recorded together with duration of hospital stay and complications.ResultsCalculated blood loss, hidden blood loss, and postoperative hemoglobin levels between the two groups were significantly different, with patients in the flexion group experiencing lower blood loss than those in the extension group (P < 0.05). After 6-week rehabilitation, patients from both groups attained a similar range of motion in the joint. Duration of hospital stay was shorter in the flexion group by 1.6 days. Wound infection rates were similar in both groups, and we observed no proven deep vein thrombosis.ConclusionsPostoperative elevation of the hip by 45°, with 45° knee flexion, is an effective and simple method of reducing blood loss and hospital stay following unilateral primary total knee arthroplasty.
Highlights
With an increasing number of aged people suffering from degenerative osteoarthritis of the knee, total knee arthroplasty (TKA) has become an important method for relieving pain and improving quality of life
Blood loss influences the restoration of a functional range of motion (ROM), an important factor when evaluating the success of TKA, because different ROMs are needed for different types of activity
After 6 weeks of rehabilitation, both groups had a similar ROM without statistical difference and overall patients in the flexion group spent less time in hospital than those in the extension group
Summary
With an increasing number of aged people suffering from degenerative osteoarthritis of the knee, total knee arthroplasty (TKA) has become an important method for relieving pain and improving quality of life. The procedure involves extensive soft tissue release and bone incisions, resulting in significant blood loss. Allogenic blood transfusions are generally used to prevent postoperative anemia. Blood loss influences the restoration of a functional range of motion (ROM), an important factor when evaluating the success of TKA, because different ROMs are needed for different types of activity. Recovery of a good range of motion is vital for an optimal result, and small changes in maximum flexion can have profound effects on functional capability [3]. The greatest improvement in flexion has been found at the time of patients discharged and 6 weeks postoperatively.
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