Balaboshka K.B., Khadzkou Y.K.
The possibilities of using the method of perioperative management of total knee replacement
Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
Vestnik VGMU. 2020;19(5):72-79.
Objectives. To determine the effectiveness of the proposed integrated approach to perioperative management of primary total knee replacement (TKA), revision surgery and one-stage bilateral surgery, as well as in the presence of anemia in patients at the preoperative period.
Material and methods.The prospective study included 283 patients with stage 3 osteoarthritis of the knee joint (9 patients with anemia at the preoperative stage) who underwent TKA according to primary indications and 5 patients who underwent revision surgery for aseptic instability of endoprosthesis components. A female patient with bilateral osteoarthritis of the knee joints in whom TKA was performed simultaneously on both sides was also included in the study. In the treatment of all patients, the «method of perioperative management of knee replacement» was used. In the course of this study blood count before and after surgical intervention , the severity of pain syndrome according to the numeric rating scale for pain (NRS), and the functional result according to the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were evaluated.
Results. The introduction of a multimodal approach to reducing blood loss and pain intensity made it possible to eliminate the need for donated blood transfusion in all cases, to significantly reduce the level of pain syndrome in the early postoperative period, and to cut down the economic costs of treating patients with osteoarthritis of the knee joint.
Conclusions. An integrated approach to the perioperative management of knee replacement enables the effective reduction of perioperative blood loss and the intensity of pain during primary total knee replacement, and also creates favourable conditions for performing revision and simultaneous bilateral surgery, and when performing surgery in patients with anemia at the preoperative period.
Key words: knee replacement, blood loss, analgesia, perioperative management, rehabilitation.
1. Vina ER, Kwoh CK. Epidemiology of osteoarthritis: literature update. Curr Opin Rheumatol. 2018 Mar;30(2):160-167. doi: http://dx.doi.org/10.1097/BOR.0000000000000479
2. Choi YJ, Ra HJ. Patient satisfaction after total knee arthroplasty. Knee Surg Relat Res. 2016 Mar;28(1):1-15. doi: http://dx.doi.org/10.5792/ksrr.2016.28.1.1
3. Amanatullah DF, Pallante GD, Chalmers BP, Pagnano M, Sierra RJ. Perioperative management in total knee arthroplasty. Current Orthopaedic Practice. 2015 Dec;26(3):217-23. doiI: 10.1097/BCO.0000000000000230
4. Lisi C, Caspani P, Bruggi M, Carlisi E, Scolè D, Benazzo F, et al. Early rehabilitation after elective total knee arthroplasty. Acta Biomed. 2017 Oct;88(4S):56-61. doi: http://dx.doi.org/10.23750/abm.v88i4-S.5154
5. Song K, Pan P, Yao Y, Jiang T, Jiang Q. The incidence and risk factors for allogenic blood transfusion in total knee and hip arthroplasty. J Orthop Surg Res. 2019 Aug 28;14(1):273. doi: http://dx.doi.org/10.1186/s13018-019-1329-0
6. Tille E, Mysliwietz J, Beyer F, Postler A, Lützner J. Intraarticular use of tranexamic acid reduces blood loss and transfusion rate after primary total knee arthroplasty. BMC Musculoskelet Disord. 2019;20(1):341-6. doi: http://dx.doi.org/10.1186/s12891-019-2715-9
7. Liu D, Dan M, Martos SM, Beller E. Blood management strategies in total knee arthroplasty. Knee Surg Relat Res. 2016 Sep;28(3):179-87. doi: http://dx.doi.org/10.5792/ksrr.2016.28.3.179
8. Li JW, Ma YS, Xiao LK. Postoperative pain management in total knee arthroplasty. Orthop Surg. 2019 Oct;11(5):755-761. doi: http://dx.doi.org/10.1111/os.12535
9. Liu L, Liu H, Zhang H, Song J, Zhang L. Bilateral total knee arthroplasty: Simultaneous or staged? A systematic review and meta-analysis. Medicine (Baltimore). 2019 May;98(22):e15931. doi: http://dx.doi.org/10.1097/MD.0000000000015931
10. Boloboshko KB, Khodkov EK, Kubrakov KM, Abdulina ZN. The effectiveness of an integrated approach to perioperative maintenance of knee arthroplasty. Novosti Khirurgii. 2020;28(1):53-61. (In Russ.)
11. Khodkov EK, Boloboshko KB, Kubrakov KM, Usovich AK, Lovikov DN. Comparative effectiveness of analgesic methods for knee arthroplasty. Vestn VGMU. 2020;19(1):66-72. (In Russ.)
12. Johnson RL, Kopp SL. Optimizing perioperative management of total joint arthroplasty. Anesthesiol Clin. 2014 Dec;32(4):865-80. doi: http://dx.doi.org/10.1016/j.anclin.2014.08.006
13. Reichel F, Peter C, Ewerbeck V, Egermann M. Reducing blood loss in revision total hip and knee arthroplasty: tranexamic acid is effective in aseptic revisions and in second-stage reimplantations for periprosthetic infection. Biomed Res Int. 2018;2018(1):1-9. doi: http://dx.doi.org/10.1155/2018/3891870
14. Summers S, Mohile N, McNamara C, Osman B, Gebhard R, Hernandez VH. Analgesia in total knee arthroplasty current pain control modalities and outcomes. J Bone Joint Surg Am. 2020 Apr;102(8):719-727. doi: http://dx.doi.org/10.2106/JBJS.19.01035
15. Palmer A, Chen A, Matsumoto T, Murphy M, Price A. Blood management in total knee arthroplasty: state-of-the-art review. JISAKOS. 2018 Apr;3:358-66. doi:10.1136/jisakos-2017-000168
Information about authors:
Balaboshka K.B. – Candidate of Medical Sciences, associate professor, head of the Chair of Traumatology, Orthopedics & Military Surgery, Vitebsk State Order of Peoples’ Friendship Medical University,
Khadzkou Y.K. – lecturer of the Chair of Traumatology, Orthopedics & Military Surgery, Vitebsk State Order of Peoples’ Friendship Medical University,