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

Area of Science:

• Orthopedic Surgery
• Evidence-Based Medicine

Background:

• Ongoing controversies exist in total knee arthroplasty (TKA) regarding several key areas.
• Recent literature updates are crucial for informed clinical decision-making in TKA.

Purpose of the Study:

• To review recent literature (past 5 years) on controversial topics in TKA.
• To provide evidence-based guidance on venous thromboprophylaxis, tranexamic acid, tourniquet use, and wound closure.

Main Methods:

• Literature search of multiple databases focusing on studies from the last 5 years.
• Prioritization of meta-analyses and randomized controlled trials for review.

Main Results:

• Tranexamic acid is safe and effective, with potential benefits from multiple doses and administration routes.
• Certain wound closure techniques and limited tourniquet use may enhance patient satisfaction despite longer operative times.
• Postoperative anticoagulation remains controversial, with some evidence supporting extended use up to 35 days.

Conclusions:

• Surgeons can utilize updated evidence for TKA, but significant controversies persist.
• Recent literature has not resolved all debates, necessitating continued research and critical appraisal.