Knee flexion after total knee arthroplasty reduces blood loss

Abstract

Knee flexion at 90° after TKA, associated with the intraoperative use of tranexamic, acid is an effective method to reduce blood loss and the need for blood transfusion. The routine use of the present protocol is effective in reducing social costs and length of hospitalization of TKA procedures.

Impact of flexion versus extension of knee position on outcomes after total knee arthroplasty: a meta-analysis

“…Johnson has reported that knee flexion following TKA might increase wound complications by lowering oxygen tension in the wound edges [28]. Eight of the included studies [11, 14, 16, 18–22] mentioned these complications while the remaining two failed to do so [15, 17], and our study did not find any difference in wound complications between the two groups (Table 3). …”

“…There were no significant inter-group differences with regard to age, gender and body mass index (BMI). The baseline level of hemoglobin [11, 14, 17–19, 21, 22] and ROM [11, 14, 20, 22] were well balanced between the flexion group and extension group in some studies. Three RCTs were excluded due to various reasons.…”

“…Randomization was done using the random number list in four studies [11, 17–22]; the closing envelope technique [14, 16] and calendar randomization [15] were used in the remaining three. The detailed risk of bias in methodological quality of included studies is elaborated in Fig.…”

“…The first RCT on this topic was published by Speck et al [9], which found that 70° of knee flexion for 6 h after the cemented TKA significantly reduced blood loss (by 30%) as determined by wound drainage. A few studies [9, 17] have proposed that the knee position after TKA is a simple and cost-effective way to maximize patient outcomes without increasing the side effects, however, the results of these studies are debatable. To clarify this issue, we performed the present meta-analysis, which included recent RCTs comparing postsurgical flexed knee position with extended knee position.…”

Leg position influences early blood loss and functional recovery following total knee arthroplasty: A randomized study

“…A meta-analysis has indicated that the intra-articular injection of a high dosage of TXA (30 mg/ml) may reduce the total blood loss and the requirement of blood transfusions. Knee flexion at 90 after TKA with the intraoperative use of TXA is an effective method to reduce blood loss and the need for blood transfusions [18].…”