Non-surgery factors affecting knee replacement

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.

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