The use of knee splints after total knee replacements

Post-operative limb position can influence blood loss and range of motion after total knee arthroplasty: a systematic review

“…The operations were performed by a single surgeon in one paper and [8] by different surgeons in four papers [9, 14, 19, 23]; no indications regarding the operating surgeons were supplied in the remaining two papers [20, 33]. Since implant design is thought to influence ROM [2] implants used were evaluated founding four studies [14, 19, 20, 33] in which the same prosthetic model was implanted. Although Horton et al [9] reported the use of the same prosthetic design, patella was replaced in four out of 23 cases in the splint group and in three out of 25 cases in the no‐splint group, with no statistical difference.…”

“…Post‐operative limb position protocols involved the use of extension splints [9, 33], short [19, 20, 23] or long flexion regimes [8, 14] (Table 2). Active quadriceps exercises, straight leg raise initiatives and active or passive ROM exercises using continuous passive motion machines were commenced during the first [8, 14, 19] or the second [9] post‐operative day, and rehabilitation protocols were not described in three studies [20, 23, 33].…”

“…A blinded outcome assessment was present in only two studies, whose quality level was higher [9, 14] (Table 3). Three studies revealed significant differences in terms of blood loss [14, 23, 33] (Table 4). Significant results pertaining to ROM were reported in three papers [8, 14, 33] (Table 5).…”

“…ROM) could be expected. On the other hand, the objective general Post-operative limb position regimes were very different among the studies since the effectiveness of short (24 h or less) high-degree flexion protocols [19,20,23] or longer protocols (48 h or more) involving mild [14] or high [8] degree of knee flexion and the use of post-operative extension splints [9,33] were investigated (Table 3). Regimes duration rather than knee position seems to be the most relevant difference.…”

An updated meta-analysis evaluating limb management after total knee arthroplasty—what is the optimal method?

“…First, our study included one recent high-quality RCT by Zeng et al [26] and six RCTs [34–39] written in Chinese excluded by previous reviews, which would have reduced statistical bias and publication bias. Second, our study also excluded one [29] quasi-randomized trials and two earlier trials lacking of specific data in knee flexion angle [45, 46], and subgroup analysis based on both the degree of knee flexion and duration of knee flexion was conducted, bringing about more precise conclusions. Third, we used a funnel plot to assess publication bias when the number of trials reporting the primary outcomes was ten or more, and these results indicated that publication bias was well controlled.…”