Abstract
Total knee replacement is a standard procedure for the end-staged knee joints. The main concerns at the perioperative period are infection prophylaxis, pain control, and blood loss management. Several interventions are designed to decrease the blood loss during and after the operation of total knee arthroplasty.
In the recent meta-analysis showed that early tourniquet release of the tourniquet for hemostasis increased the total measured blood loss with primary TKR about 228.7 ml. So, Intra-operative blood loss for hemostasis can be saved by not to release the tourniquet after implants fixation, irrigation, closure of the wound and the application of compression dressing.
Our study showed that most of the post-operative blood loss was collected during the first few postoperative hours: 37% in the first 2 hours and 55% in the first 4 hours and 82.1% in the first 24 hours. So, clamping the drainage for the first 4 postoperative hours would reduce blood loss after TKA (518 v.s. 843 mL). The fall in hemoglobin and Hct are also of significant difference (1.64 vs. 2.09 for Hb; 5.18 vs.7.69 for Hct).
Appropriate clamping for an optimal time may be the most economical and simple, and the benefits of clamping also appear to outweigh its potential risks.
NO DRAIN at all is able to reduce the post-operative blood loss. Our study showed that the decrease of postoperative hemoglobin was significantly less than that in no-drain group (1.45±0.72 vs 1.8±0.91). Shorter hospital stay was achieved in the no-drain group (8.3 ± 2.6 vs 10.7±3.2 days). All patients achieved good range of motion (flexion: 0 to >90 degree)by the five days after operation and no prosthetic infection was noted during follow-up. Thus, the routine use of closed suction drains for elective minimal-invasive total knee arthroplasty is not recommended.
