Effect of different postoperative limb positions on blood loss and range of motion in total knee arthroplasty: An updated meta-analysis of randomized controlled trials
| Autor: | Canfeng Li, Ti-min Yang, Haibo Si, Yuangang Wu, Bin Shen, Yi Zeng |
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| Rok vydání: | 2016 |
| Předmět: |
musculoskeletal diseases
medicine.medical_specialty Knee Joint Total knee arthroplasty Subgroup analysis Postoperative Hemorrhage Patient Positioning law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Blood loss law medicine Humans Blood Transfusion 030212 general & internal medicine Range of Motion Articular Arthroplasty Replacement Knee Randomized Controlled Trials as Topic Postoperative Care 030222 orthopedics business.industry Total blood loss General Medicine Osteoarthritis Knee musculoskeletal system Surgery body regions Sample size determination Anesthesia Meta-analysis Range of motion business |
| Zdroj: | International journal of surgery (London, England). 37 |
| ISSN: | 1743-9159 |
| Popis: | Postoperative limb positioning has been reported to be an efficient and simple way to reduce blood loss and improve range of motion following total knee arthroplasty (TKA). This meta-analysis was designed to compare the effectiveness of two different limb positions in primary TKA.A meta-analysis of the PubMed, CENTRAL, Web of Science, EMBASE and Google Search Engine electronic databases was performed. In this meta-analysis, two postoperative limb positions were considered: mild-flexion (flexion less than 60°) and high-flexion (flexion at 60° or more). The subgroups were analysed using RevMan 5.3.Nine RCTs were included with a total sample size of 913 patients. The mild- and high-flexion positions significantly reduced postoperative total blood loss (P = 0.04 and P = 0.01; respectively). Subgroup analysis indicated that knee flexion significantly reduced hidden blood loss when the knee was fixed in mild-flexion (P = 0.0004) and significantly reduced transfusion requirements (P = 0.03) and improved range of motion (ROM) (P 0.00001) when the knee was fixed in high-flexion. However, the rates of wound-related infection, deep venous thrombosis (DVT) and pulmonary embolism (PE) did not significantly differ between the two flexion groups.This meta-analysis suggests that mild- and high-flexion positions have similar efficacy in reducing total blood loss. In addition, subgroup analysis indicates that the mild-flexion position is superior in decreasing hidden blood loss compared with high-flexion; the high-flexion position is superior to mild-flexion in reducing transfusion requirements and improving postoperative ROM. Thus, the use of the high-flexion position is a viable option to reduce blood loss in patients following primary TKA without increasing the risk of wound-related infection, DVT or PE. |
| Databáze: | OpenAIRE |
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