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Review
. 2020 Jan 6;4(1):e19.00048.
doi: 10.5435/JAAOSGlobal-D-19-00048. eCollection 2020 Jan.

Controversial Topics in Total Knee Arthroplasty: A Five-Year Update (Part 2)

Johannes Michiel van der Merwe  1 , Matthew Semrau Mastel  1
Affiliations
Review

Controversial Topics in Total Knee Arthroplasty: A Five-Year Update (Part 2)

Johannes Michiel van der Merwe et al. J Am Acad Orthop Surg Glob Res Rev. .

Abstract

This review article examines updates to the literature during the past 5 years on numerous topics which were felt to have ongoing controversy. These topics include venous thromboprophylaxis, tranexamic acid usage, tourniquet usage, and wound closure techniques.

Methods: For each individual topic, a literature search was conducted on several databases with emphasis on studies that were published in the past 5 years. Preference was given to meta-analyses and randomized controlled trials.

Results: Tranexamic acid is a safe and effective treatment modality, and consideration should be given to use multiple doses and combine different modes of administration. Certain treatment modalities (skin sutures, limited or no tourniquet usage) can cause greater patient satisfaction at a cost of longer operating times. Postoperative anticoagulation is still a very controversial topic. There is however some evidence suggesting prolonging anticoagulation to 35 days postoperative.

Conclusions: By analyzing the results of the aforementioned studies, surgeons can implement the most up-to-date evidence-based care when doing total knee arthroplasty surgery. However, many of these selected topics continue to have a component of ongoing controversy with no definitive conclusions developed in recent literature.

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Conflict of interest statement

Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. van der Merwe and Dr. Mastel.

Figures

Figure 1
Figure 1
Photograph of Covidien V-Loc 180 suture demonstrating an example of unidirectional barbed suture.
See this image and copyright information in PMC

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