The effect of knee position on blood loss and range of motion following total knee arthroplasty

Knee

Abstract

Purpose

This study prospectively assessed the effects of knee position on blood loss and range of motion after primary total knee arthroplasty (TKA).

Methods

One hundred and ten consecutive TKA patients were randomized into flexion group and extension group. Both groups had the leg elevated 30° at the hip over an inactive CPM for 72 h postoperatively. The flexion group had the knee flexed to 30° during this period. The extension group had the knee extended fully. Perioperative blood loss, hidden blood loss, knee swelling, ecchymosis, analgesia requirements, range of motion (ROM), fixed flexion deformity (FFD), straight-leg raising action, and postoperative complications within 6 weeks of surgery were measured for evaluation and comparison.

Results

The postoperative hidden blood loss, knee swelling, and scope of ecchymosis were significantly lower in the flexion group than in the extension group, and ROM and straight-leg raising action were significantly higher during the early period after operation. No significant difference was observed in perioperative blood loss, the amount of morphine used, or FFD in the early postoperative period or in ROM and FFD at 6 weeks postoperatively.

Conclusions

The findings of this study indicate that flexion of the knee to 30° with the leg elevated 30° at the hip after total knee arthroplasty may mitigate knee swelling and provide other beneficial results during the early rehabilitation following TKA.

Level of evidence

Prospective comparative study, Level I.

Keywords

Total knee arthroplasty Postoperative management Blood loss Leg position Flexion Extension 

References

  1. 1.
    Carson JL, Duff A, Poses RM, Berlin JA, Spence RK, Trout R, Noveck H, Strom BL (1996) Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet 348:1055–1060PubMedCrossRefGoogle Scholar
  2. 2.
    Chotanaphuti T, Ongnamthip P, Teeraleekul K, Kraturerk C (2008) Comparative study between computer assisted-navigation and conventional technique in minimally invasive surgery total knee arthroplasty, prospective control study. J Med Assoc Thai 91:1382–1388PubMedGoogle Scholar
  3. 3.
    Erskine JG, Fraser C, Simpson R, Protheroe K, Walker ID (1981) Blood loss with knee joint replacement. J R Coll Surg Edinb 26:295–297PubMedGoogle Scholar
  4. 4.
    Fehring TK, Odum SM, Griffin WL, McCoy TH, Masonis JL (2007) Surgical treatment of flexion contractures after total knee arthroplasty. J Arthroplasty 22(62):6 Suppl 2–6 Suppl66Google Scholar
  5. 5.
    Gross JB (1983) Estimating allowable blood loss: corrected for dilution. Anesthesiology 58:277–280PubMedCrossRefGoogle Scholar
  6. 6.
    Hewitt B, Shakespeare D (2001) Flexion vs. extension—a comparison of postoperative total arthroplasty mobilisation regimes. Knee 8:305–309PubMedCrossRefGoogle Scholar
  7. 7.
    Horstmann WG, Slappendel R, van Hellemondt GG, Wymenga AW, Jack N, Everts PA (2011) Autologous platelet gel in total knee arthroplasty: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 19:115–121PubMedCrossRefGoogle Scholar
  8. 8.
    Horton TC, Jackson R, Mohan N, Hambidge JE (2002) Is routine splintage following primary total knee replacement necessary? A prospective randomised trial. Knee 9:229–231PubMedCrossRefGoogle Scholar
  9. 9.
    Jergeson HE, Poss R, Sledge CB (1978) Bilateral total hip and knee replacements in adults with rheumatoid arthritis: an evaluation of function. Clin Orthop Relat Res 137:120–128Google Scholar
  10. 10.
    Johnson DP (1993) Infection after knee arthroplasty. Clinical studies of skin and wound healing. Acta Orthop Scand Suppl 252:1–48PubMedGoogle Scholar
  11. 11.
    Kullenberg B, Ylipää S, Söderlund K, Resch S (2006) Postoperative cryotherapy after total knee arthroplasty: a prospective study of 86 patients. J Arthroplasty 21:1175–1179PubMedCrossRefGoogle Scholar
  12. 12.
    Lee DH, Choi J, Nha KW, Kim HJ, Han SB (2011) No difference in early functional outcomes for mini-midvastus and limited medial parapatellar approaches in navigation-assisted total knee arthroplasty: a prospective randomized clinical trial. Knee Surg Sports Traumatol Arthrosc 19:66–73PubMedCrossRefGoogle Scholar
  13. 13.
    Li B, Wen Y, Wu H, Qian Q, Lin X, Zhao H (2009) The effect of tourniquet use on hidden blood loss in total knee arthroplasty. Int Orthop 33:1263–1268PubMedCrossRefGoogle Scholar
  14. 14.
    Ma T, Khan RJ, Carey Smith R, Nivbrant B, Wood DJ (2008) Effect of flexion/extension splintage post total knee arthroplasty on blood loss and range of motion—a randomised controlled trial. Knee 15:15–19PubMedCrossRefGoogle Scholar
  15. 15.
    Marulanda GA, Krebs VE, Bierbaum BE, Goldberg VM, Ries M, Ulrich SD, Seyler TM, Mont MA (2009) Hemostasis using a bipolar sealer in primary unilateral total knee arthroplasty. Am J Orthop (Belle Mead NJ) 38:E179–E183Google Scholar
  16. 16.
    Mylod AG, France MP, Muser DE, Parsons JR (1990) Perioperative blood loss associated with total knee arthroplasty. A comparison of procedures performed with and without cementing. J Bone Joint Surg Am 72:1010–1012PubMedGoogle Scholar
  17. 17.
    Nadler SB, Hidalgo JU, Bloch T (1962) Prediction of blood volume in normal human adults. Surgery 51:224–232PubMedGoogle Scholar
  18. 18.
    Ong SM, Taylor GJ (2003) Can knee position save blood following total knee replacement? Knee 10:81–85PubMedCrossRefGoogle Scholar
  19. 19.
    Ritter MA, Lutgring JD, Davis KE, Berend ME, Pierson JL, Meneghini RM (2007) The role of flexion contracture on outcomes in primary total knee arthroplasty. J Arthroplasty 22:1092–1096PubMedCrossRefGoogle Scholar
  20. 20.
    Schröder D, Pässler HH (1994) Combination of cold and compression after knee surgery. Knee Surg Sports Traumatol Arthrosc 2:158–165PubMedCrossRefGoogle Scholar
  21. 21.
    Stucinskas J, Tarasevicius S, Cebatorius A, Robertsson O, Smailys A, Wingstrand H (2009) Conventional drainage versus four hour clamping drainage after total knee arthroplasty in severe osteoarthritis: a prospective, randomised trial. Int Orthop 33:1275–1278PubMedCrossRefGoogle Scholar
  22. 22.
    Zenios M, Wykes P, Johnson DS, Clayson AD, Kay P (2002) The use of knee splints after total knee replacements. Knee 9:225–228PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryShengjing Hospital, China Medical UniversityShenyangChina
  2. 2.College of Basic Medical SciencesChina Medical UniversityShenyangChina

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