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TKR: Patient Positioning, Prepping and Draping

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