Methods to Prevent Infection:
-
prophylactic antibiotics:
-
skin prep agents:
- Considerations:
- patient is placed in supine position, hip bump is optional;
-
tourniquet:
- in the study by HM Wakankar et al (JBJS Vol 81 Jan 1999 p 30) the authors prospectively studied the effect of tourniquet on TKR patients;
- the authors found no increased
risk of DVT in patients that received a tourniquet;
- the study could be criticized for having too few patients inorder to make a reasonable conclusio
- if pulses are dopplerable but are not palpable, then consider proceding with the case but avoid use of the tourniquet;
-
foot bump:
- tape a rolled sheet (bump) to the table, which will help keep the knee hyper-flexed during the case;
- it is important not to place the bump too far proximally (which will not allow the knee to be held in a flexed position);
-
OR lights:
- position the OR lights prior to prepping;
- there is some evidence that the "sterile" OR light handles are a common source of contaminant during surgery, and ideally
these should not be touched during the case;
The efficacy of tourniquet release in blood conservation after total knee arthroplasty.
Blood loss after total knee replacement. Effects of tourniquet release and continuous passive motion.
Time-Dependent Contamination of Opened Sterile Operating-Room Trays
