Background: Total knee replacement (TKR) is a major orthopedic surgery that is considered high risk for the development of venous thromboembolism (VTE). Objective: The aim of this study is to evaluate the clinical outcomes that resulted from the use of a new proposed VTE risk stratification protocol for selecting a suitable extended VTE prophylaxis for post TKR surgery patients administered in conjunction with patient education programs. Method: A randomized controlled trial was conducted in two medical centers in Saudi Arabia. A total of 242 patients were enrolled in the study, 121 patients in each group. The experimental group (A) was assessed by using the proposed VTE risk stratification protocol and also took part in patient education programs about TKR and its complications. The control group (B) was assessed by using the 2005 Caprini risk assessment tool and no education programs were given to this group. Both groups were followed for 35 days post operation. Results: The mean age of the participants was 65.86 (SD 8.67) and the majority of them were female 137 (56.6%). The mean body mass index of the study sample was 32.46 (SD 5.51). There were no significant differences between the two groups except for surgery type; the proportion of bilateral TKR in group A was higher than in group B (69/121 (28.5%) vs. 40/121(16.5%), p˂0.05). There were no confirmed pulmonary embolism cases in the study sample and diagnosis of deep-vein thrombosis was confirmed in 12/242 (5.0%) of patients: 1/121 (0.8%) in group A and 11/121 (9.1%) in group B (p˂0.05). The readmission rate for all patients was 2.5% (6/242), all of whom were in group B (p˂0.05). Conclusion: The proposed VTE risk stratification protocol that was applied in conjunction with patient education programs reduced VTE complications and readmission events, post TKR surgery. Trial Registration: ClinicalTrials.gov Identifier: NCT04031859.

Background: Total Knee Replacement (TKR) has been the most successful intervention that reduces knee pain and improves physical function of rheumatoid arthritis patients. This study aims to compare the complications and recovery for bilateral versus unilateral TKR within 35 days of post-surgery. Method: This is a prospective observational study that was done in two medical centres in Saudi Arabia. All patients who underwent primary TKR surgery in the included medical centres between the period of October 2018 till July 2019 were eligible for this study. A prospective data collection sheet was used to follow up for each patient for 35 days of post-surgery. Results: 242 patients were involved in this study. The mean age for unilateral TKR patients was 66.95 ± 8.91 years, whereas 64.53 ± 8.88 years for bilateral TKR patients. Days required to start walking post-operation of unilateral TKR were significantly higher than that of bilateral TKR (2.66 ± 1.13 days versus 2.30 ± 0.98 days). Deep vein thrombosis (DVT) was found in bilateral TKR 11 (4.5%) more than 4 (1.7%) unilateral TKR. Confirmed diagnosis (pulmonary embolism (PE) or DVT) was observed in 10 (4.2%) bilateral TKR more than unilateral TKR 2 (0.8%). Conclusion: There are significant differences between bilateral and unilateral TKR in terms of recovery and DVT complications. Highlights:

Background Acute pain in post joint replacement surgeries is common, which makes the management of acute pain following joint replacement surgeries to be very important. Thus, this study was conducted to evaluate acute pain management of post TKR surgeries. Results Patients with negative pain management index (PMI) scores were classified as receiving inadequate analgesic treatment for their pain. Zero PMI was the most frequent score among the others with 195 (80.6%). The rest were − 1 (11 (4.5%)), 1 (27 (11.2%)), and 2 (9 (3.7%)), respectively. Only 4.5% (11/242) patients have negative PMI score, which could be considered as inadequate pain management in which these patients received inadequate analgesic treatment. Conclusion Acute pain management in post-TKR surgeries in both medical centers achieved an acceptable level, and majority of patients received an adequate analgesia in post-TKR surgeries.