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Non-surgery factors affecting knee replacement

knee replacement wound being infiltrated with long-acting anaesthetic agent

The AAOS (American Association of Orthopaedic Surgeons) have published guidelines for those non-surgery factors influencing the outcome of total knee arthroplasty (TKA) - also called total knee replacement (TKR). I have summarised these for you to make items easy to refer to and remember.

Positive influence on outcome

  • Local infiltration analgesia
  • Peripheral Nerve Blocks
  • Neuraxial Anaesthesia
  • Tourniquet Use (for intra-operative blood loss reduction)
  • Tranexamic Acid
  • All Poly Tibial Insert
  • No Drain
  • Cryotherapy
  • Early Rehabilitation (from first post-operative day)
  • Early Stage Physiotherapy (<2 months)

Negative influence on outcome

  • Obesity
  • Diabetes
  • Chronic pain
  • Depression / Anxiety
  • Delay in surgery (>8 months)
  • Tourniquet use (increase in post-operative pain)
  • Tourniquet use (decrease in post-operative function)
  • Cryotherapy

Reference: Surgical Management of Osteoarthritis of the knee - evidence-based clinical practice guidelines

Professor Raju Vaishya

MBBS, MS, MCh (Liverpool), FRCS (Lon)
Indraprastha Apollo Hospitals,
New Delhi, INDIA
email: [email protected]

Squeezing blood out of the leg with a rubber bandage before inflating the tourniquet

Tourniquet - yes or no?

"As surgeons, we are always looking for ways to improve the outcome for our patients after surgery. It is not only the surgery itself that influences outcome, but other factors may positively or negatively affect things."


Local infiltration analgesia

Peripheral Nerve Blocks

Neuraxial anaesthesia


Tranexamic acid


Yasin says May 13, 2016

Greatful informations

    Raju Vaishya says May 17, 2016

    Thank you,. Yasin for your liking.

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