Year 2020 Vol. 28 No 1




Vitebsk State Medical University, Vitebsk,
The Republic of Belarus

Objective. To improve the results of total knee replacement by creating conditions for the early active rehabilitation of a patient on the basis of the integrated approach to reduce perioperative blood loss and pain intensity.
Methods. A prospective, comparative clinical study was conducted involving 100 patients with the knee osteoarthritis of the 3rd stage who had undergone primary total knee replacement. Monolateral spinal anesthesia, preemptive analgesia, combined administration of aminocaproic acid and local infiltration analgesia considering the anatomy of the main neural structures were used in the treatment of patients of the study group (n=50). In the control group (n=50) surgeries were performed using spinal anesthesia, without the use of preemptive analgesia, inhibitors of fibrinolysis and local infiltration analgesia. The volume of perioperative blood loss, hematological parameters (hemoglobin, erythrocytes, hematocrit), frequency of transfusion of donor blood components, pain syndrome, functional result were evaluated.
Results. The total volume of the perioperative blood loss in patients of the control group was 1425 (911; 1762) ml and was significantly higher (p<0.01) than in the study group 943 (758; 1135) ml, which required transfusion of donor blood components to 11 patients of the control group. The average value of erythrocytes, hemoglobin and hematocrit in the postoperative period in patients of the study group was significantly higher than in the control group (p<0,01). The intensity of pain syndrome was significantly lower in patients of the study group both at rest and with movements in the knee joint (p<0,01). We observed statistically significantly better functional result in patients of the study group (p<0,01).
Conclusions. The integrated approach to perioperative management of knee replacement allows reducing the volume of total blood loss, eliminating the need for donor blood transfusion, reducing the intensity of pain syndrome, which creates favorable conditions for patients early active rehabilitation, improves the functional result and reduces economic costs.

Keywords: knee replacement, blood loss, analgesia, perioperative management, rehabilitation
p. 53-61 of the original issue
  1. Neogi T. The epidemiology and impact of pain in osteoarthritis. Osteoarthritis Cartilage. 2013 Sep;21(9):1145-53. doi: 10.1016/j.joca.2013.03.018
  2. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007 Apr;89(4):780-85. doi: 10.2106/JBJS.F.00222
  3. Liu D, Dan M, Martinez Martos S, Beller E. Blood management strategies in total knee arthroplasty. Knee Surg Relat Res. 2016 Sep;28(3):179-87. doi: 10.5792/ksrr.2016.28.3.179
  4. Chan EY, Blyth FM, Nairn L, Fransen M. Acute postoperative pain following hospital discharge after total knee arthroplasty. Osteoarthritis Cartilage. 2013 Sep;21(9):1257-63. doi: 10.1016/j.joca.2013.06.011
  5. Feng JE, Novikov D, Anoushiravani AA, Schwarzkopf R. Total knee arthroplasty: improving outcomes with a multidisciplinary approach. J Multidiscip Healthc. 2018 Jan 25;11:63-73. doi: 10.2147/JMDH.S140550
  6. Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology. 1983 Mar;58(3):277-80. doi: 10.1097/00000542-198303000-00016
  7. Bogomolov AN, Kanus II. Anesthesia provision and postoperative analgesia at total endoprosthesis of the knee joint. Novosti Khirurgii. 2012;20(6):102-10. (In Russ.)
  8. 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: 10.1186/s13018-019-1329-0
  9. 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 Jul 27;20(1):341. doi: 10.1186/s12891-019-2715-9
  10. Zhang S, Wang C, Shi L, Xue Q. Multi-route applications of tranexamic acid to reduce blood loss after total knee arthroplasty: a randomized controlled trial. Medicine (Baltimore). 2019 Jul;98(30):e16570. doi: 10.1097/MD.0000000000016570
  11. Harper RA, Sucher MG, Giordani M, Nedopil AJ. Topically applied Epsilon-Aminocaproic acid reduces blood loss and length of hospital stay after total knee arthroplasty. Orthopedics. 2017 Nov 1;40(6):e1044-e1049. doi: 10.3928/01477447-20170925-07
  12. Engel JM, Hohaus T, Ruwoldt R, Menges T, Jürgensen I, Hempelmann G. Regional hemostatic status and blood requirements after total knee arthroplasty with and without tranexamic acid or aprotinin. Anesth Analg. 2001 Mar;92(3):775-80. doi: 10.1097/00000539-200103000-00041
  13. Dalury DF. A state-of-the-art pain protocol for total knee replacement. Arthroplast Today. 2016 Feb 12;2(1):23-25. doi: 10.1016/j.artd.2016.01.004
  14. Halawi MJ, Grant SA, Bolognesi MP. Multimodal analgesia for total joint arthroplasty. Orthopedics. 2015 Jul 1;38(7):e616-25. doi: 10.3928/01477447-20150701-61
  15. Gerasimenko MA, Zhuk YV, Vrublevsky VA, Lenkovets AS, Kozlova VI. Perioperative anesthesia in total knee arthroplasty. Med Zhurn. 2018(2):39-42. (In Russ.)
  16. Berninger MT, Friederichs J, Leidinger W, Augat P, Bühren V, Fulghum C, Reng W. Effect of local infiltration analgesia, peripheral nerve blocks, general and spinal anesthesia on early functional recovery and pain control in total knee arthroplasty. BMC Musculoskelet Disord. 2018 Jul 18;19(1):232. doi: 10.1186/s12891-018-2154-z
  17. Zhang Z, Shen B. Effectiveness and weakness of local infiltration analgesia in total knee arthroplasty: a systematic review. J Int Med Res. 2018 Dec;46(12):4874-84. doi: 10.1177/0300060518799616
Address for correspondence:
210009, Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
Department of Traumatology, Orthopedics
And Military Field Surgery.
Tel. office: +375(212)574084,
Kanstantsin B. Balaboshka
Information about the authors:
Balaboshka Kanstantsin B., PhD, Associate Professor, Head of the Department of Traumatology, Orthopedics and Military Field Surgery, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
Khadzkou Yauheni K., Assistant of the Department of Traumatology, Orthopedics and Military Field Surgery, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
Kubrakov Konstantsin M., PhD, Associate Professor of the Neurology and Neurosurgery Department, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
Abdulina Ziamfira N., Assistant of the Department of Anesthesiology and Intensive Care with the Course of the Faculty of Advanced Training and Retraining, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
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