The Effect Of Knee Position On Blood Loss After Initial Total Knee Arthroplasty

Objective:It is necessary to determine a more effective limb position to reduce bleeding after TKA,which could provide help and guidance for clinical work in future.Method:60 osteoarthritis patients(13 male patients and 47 female patients)with unilateral TKA surgery operated in our hospital from January 2015 to June 2016 were included in the study.The subject were randomly divided into experimental group and control group,while the experimental group A covered 30 cases(7 male cases,23 female cases,the average age was 64 years old,there were 18 patients undergoing left TKA and 12 patients undergoing right TKA).Hip joint flexion was lift at 45 degree and knee joint flexion was lift at 60 degree for 6 hours after the operation;Control group B covered 30 cases(6 male cases,24 female cases,the average age was 67 years old,there were 19 patients undergoing left TKA and 11 patients undergoing right TKA).Hip joint and knee joint were kept in extension position after operation.Patient basic physical condition information,24-hour incision drainage volume,preoperative and postoperative hemoglobin value,allogeneic blood transfusion and the total volume of blood transfusion were recorded accurately between two groups after the operation.In addition,knee joint range of motion at the fifth day,surgical incision dehiscence,purulent secreting and the healing of incision were observed and compered between two groups.Postoperative double lower limb angiography were required to operate after 7 days aiming to examine deep vein thrombosis.Result:1.There were no statistical differences between the two groups in basic physical condition information and preoperative 24 h Hb hemoglobin and hematocrit of Hct.2.There was no significant difference in postoperative hospitalization time,13.3 and 13.4 days respectively and p=0.9.Knee joint range of motion at the fifth day also had no significant difference and the figures were 113 degree and 117 degree with p=0.13.Each group had one deep venous thrombosis postoperatively after 7 days and they had no significant difference.There were no surgical wound bad healing and infection in two groups postoperatively.The two groups did not see statistically significant difference in intraoperative blood loss volume,206 ml and 210 ml respectively,p=0.84.3.There was significant difference between the two groups in postoperative incision drainage volume at 172 ml and 272 ml respectively,p=0.03<0.05.Similarly,there was significant difference between the two groups in total blood loss at 803 ml and 1059 ml and P =0.003<0.05.The experimental group and control group had significant difference according to the GROSS equation in hidden blood loss,respectively 428 ml and 576 ml,p=0.034<0.05.Conclusion:Hip joint flexion lifting at 45 degree and knee joint flexion lifting at 60 degree can help to reduce the postoperative total blood loss,incision drainage volume and hidden blood loss without increasing the hospitalization time,complication rate and limb function at the same time.So placing the knee up to the thigh lifting at 60 degrees,bending knees 45 degrees is a simple,safe,effective and cost-effective method to reduce postoperative bleeding and it is worthy of clinical promotion.