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- Title
Meta-analysis of Temporary Versus No Clamping in TKA.
- Authors
Huang, ZeYu; Ma, Jun; Pei, FuXing; Yang, Jing; Zhou, ZongKe; Kang, PengDe; Shen, Bin
- Abstract
Educational Objectives As a result of reading this article, physicians should be able to: 1. Identify the available drainage systems used for patients who undergo total knee arthroplasty (TKA). 2. Understand the potential strengths and limitations of temporary and no clamping drainage used in TKA. 3. Become familiar with the available evidence regarding the advantages of temporary and no clamping drainage used in TKA. 4. Understand the optimal time of temporary drainage clamping in association with TKA based on the available evidence. Use of closed drainage systems after total knee arthroplasty (TKA) is a routine practice. Currently, a debate exists regarding whether temporary or no clamping is optimal. A systematic review of the English literature was conducted, and randomized controlled trials comparing all forms of temporary or no clamping drainage were included. Two authors independently extracted articles and predefined data. Data were pooled using a fixed-effects model to perform the meta-analysis. Nine randomized controlled trials totaling 850 patients were retrieved. The results indicate that temporary clamping could significantly reduce the drainage volume, including total drainage volume, drainage volume within 24 hours postoperatively, and drainage volume within 48 hours postoperatively. Furthermore, patients treated with temporary drainage clamping for 4 hours or more had a higher hemoglobin level 24 hours postoperatively than the patients treated with no clamping, and the number of blood transfusions per patient decreased significantly. No significant difference was identified between the 2 practices regarding postoperative range of motion, wound-related complications, and deep vein thrombosis. More randomized controlled trials are needed to provide robust evidence and to definitively determine which practice is most effective in reducing postoperative blood loss. Total knee arthroplasty (TKA) is routinely used to treat end-stage knee osteoarthritis. It is well tolerated, and, in correctly selected patients, the results are satisfactory in a high portion of patients. However, significant blood loss after TKA can occur.1,2 Transfusions have substantial complication risks, such as immunological reactions, disease transmission, transfusion-associated circulatory overload, transfusion-related acute lung injury, real failure, and transfusion-induced coagulopathy, and should be avoided if possible..3,4 Many blood-conserving measures have been developed to reduce blood loss and postoperative transfusion rates.
- Publication
Orthopedics, 2013, Vol 36, Issue 7, p539
- ISSN
0147-7447
- Publication type
Article
- DOI
10.3928/01477447-20130624-11