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 Wakankar HM, et al (1999) 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;
- references:
- Tourniquet cuff pressure: the gulf between science and practice.
- The tourniquet in total knee arthroplasty. A prospective, randomised study.
- Lower tourniquet cuff pressure reduces postoperative wound complications after total knee arthroplasty: a randomized controlled study of 164 patients.
- 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
Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach.
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
Sterile stockinette in orthopaedic surgery: a possible pathway for infection