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Primary Total Knee Replacement: A Recipe for Dry Dressing.

Muhammad Azfar Khanzada1, Omer Adil Awadelkarim1, Tarig Abdel Rahman2

  • 1Orthopedics, Dr. Sulaiman Al Habib Suwaidi Hospital, Riyadh, SAU.

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|May 22, 2023
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Summary

This study shows that a combination of surgical techniques can achieve a dry wound dressing for two weeks after total knee replacement (TKR). This approach improved outcomes and patient satisfaction in Saudi Arabia.

Keywords:
carboxymethylcellulose sodiumosteoarthritisperioperative caresurgical outcometotal knee replacement (tkr)

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Area of Science:

  • Orthopedic Surgery
  • Surgical Innovation
  • Patient Outcomes

Background:

  • Total knee replacement (TKR) is a common procedure for end-stage knee osteoarthritis.
  • Achieving optimal surgical outcomes, including minimizing complications and ensuring patient comfort, remains a key focus in TKR.
  • Maintaining a dry wound dressing post-operatively is crucial for preventing infection and promoting healing.

Purpose of the Study:

  • To evaluate a specific set of surgical techniques aimed at achieving a single, dry wound dressing for two weeks following total knee replacement.
  • To assess the impact of these techniques on surgical outcomes such as blood loss, infection rates, and patient satisfaction.

Main Methods:

  • A prospective study involving 110 patients undergoing unilateral TKR for primary knee osteoarthritis (Kellgren-Lawrence grades 3-4).
  • Implementation of a multi-modal technique including minimal tourniquet use, intravenous tranexamic acid, no drains, local anesthetic infiltration, layered closure with barbed sutures, skin glue, Aquacel dressing, adductor canal block, and oral anticoagulants.
  • Patients were monitored for wound healing, complications, and overall outcomes.

Main Results:

  • The study included 110 patients (73.6% female, mean age 60.5 years, mean BMI 30.57 kg/m²).
  • No statistically significant difference in preoperative and postoperative hemoglobin levels was observed (p=0.28).
  • Only two patients required a dressing change due to minor ooze; no cases of deep venous thrombosis (DVT) or surgical site infection were reported.

Conclusions:

  • The sequential application of the evaluated surgical techniques significantly improves outcomes in total knee replacement.
  • This approach leads to reduced blood loss, lower infection rates, enhanced mobility, and increased patient satisfaction.
  • The primary endpoint of a dry Aquacel wound dressing maintained for two weeks was successfully achieved, indicating the efficacy of the combined techniques.