Controlled hypotension technology can improve patient recovery in the early postoperative period after total knee arthroplasty: A prospective, randomized controlled clinical study

Abstract

Objectives: The study aimed to analyze the application of controlled hypotension and tourniquets in total knee arthroplasty (TKA) to evaluate their early postoperative period effects in TKA.

Patients and methods: A total of 183 patients (43 males, 140 females; mean age: 67.8±6.4 years; range, 50 to 84 years) with knee osteoarthritis who needed TKA were recruited for this prospective, randomized controlled clinical study between August 2022 and May 2023. The study included a tourniquet group (group T, 94 patients) and a controlled hypotension group (group H, 89 patients). In group T, an inflatable tourniquet was used throughout the operation, with the pressure of the tourniquet set at 300 mmHg. In group H, controlled hypotension was used, with the mean arterial pressure controlled at 55-65 mmHg. The outcome measures of this study included blood loss, coagulation function, inflammatory mediators, knee joint function, permeation thickness of bone cement around the tibial prosthesis, and cognitive function.

Results: The baseline demographics and clinical characteristics of the two groups of patients were comparable (p>0.05). Intraoperative blood loss in group H was higher than that in group T (p<0.05), whereas hemoglobin decrease, postoperative drainage flow, hidden blood loss, and total blood loss in group T were higher than in group H (p<0.05). Fibrinogen, D-dimer, C-reactive protein, and interleukin-6 levels were higher in group T than in group H on the first and third postoperative days (p<0.05). The knee joint function of group H was significantly better than that of group T on the fifth day and one month after the operation (p<0.05). There was no significant difference in the penetration thickness of bone cement around the tibial prosthesis between the two groups (p>0.05). There was no significant difference in Mini-Mental State Examination scores between the two groups on the same day (p>0.05).

Conclusion: Controlled hypotension technology in TKA can reduce total blood loss by reducing hidden blood loss and can help to alleviate the postoperative hypercoagulable state, relieve inflammatory reactions, and facilitate early recovery of knee joint function after surgery.

* The two authors contributed equally to this study

Citation: Li X, Liu J, Wang H, Ding Y. Controlled hypotension technology can improve patient recovery in the early postoperative period after total knee arthroplasty: A prospective, randomized controlled clinical study. Jt Dis Relat Surg 2024;35(1):36-44. doi: 10.52312/jdrs.2023.1379.

The study protocol was approved by the Fuyang People's Hospital Medical Ethics Committee (date: 18.01.2022, no: 2022-8). The study was conducted in accordance with the principles of the Declaration of Helsinki.

A written informed consent was obtained from each patient.

Idea/concept, control/supervision, critical review, design, references: H.W., Y.D.; Data collection and/or processing, literature review, writing the article: X.L., J.L.; Analysis and/or interpretation: X.L., J.L., H.W., Y.D.

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

This work was supported by the Fuyang Municipal Health Commission (FY2021-009), Fuyang Science and Technology Bureau (FK202081028, FK202081029), Anhui Provincial Clinical Medical Research Center for Spinal Deformities (AHJZJX-GG2022-003), and Scientific Research Fund of Anhui Medical University (2022xkj084).

The data that support the findings of this study are available from the corresponding author upon reasonable request.