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Continuous Hemodynamic Monitoring and Goal-Directed Therapy for Optimization in Total Knee Replacement: A Prospective
Christos Christofis1, Martha Kyriakou2, Alexandra Arvanitaki3,4
1Department of Anesthesiology, University General Hospital of Alexandroupolis, Democritus University of Thrace, Nicosia, CYP.
Cureus
|January 8, 2026
Summary
Goal-directed fluid therapy (GDT) using non-invasive monitoring reduced fluid administration and improved recovery in knee surgery patients. This approach optimized hemodynamics, leading to shorter post-anesthesia care unit stays.
Area of Science:
- Anesthesiology
- Critical Care Medicine
- Surgical Outcomes
Background:
- Optimizing perioperative hemodynamics is crucial for patient recovery.
- Goal-directed fluid therapy (GDT) tailors fluid administration to individual patient needs.
- Non-invasive hemodynamic monitoring offers a potential advancement in fluid management.
Purpose of the Study:
- To evaluate the efficacy of GDT guided by the ClearSight monitoring system.
- To assess hemodynamic parameters, fluid administration, and postoperative outcomes in total knee arthroplasty (TKA) patients.
- To compare GDT with standard fluid therapy under spinal anesthesia.
Main Methods:
- Prospective observational study involving 40 TKA patients.
- Patients were managed with either a GDT protocol or standard fluid therapy.
- Continuous non-invasive hemodynamic monitoring using the ClearSight system was employed for the GDT group.
Main Results:
- The GDT group received significantly less intraoperative crystalloid volume.
- Patients in the GDT group experienced a shorter post-anesthesia care unit (PACU) stay.
- More stable mean arterial pressure was observed in the GDT group throughout the procedure.
Conclusions:
- Continuous non-invasive hemodynamic monitoring enhances intraoperative fluid optimization.
- GDT improves immediate recovery following orthopedic surgery, specifically TKA.
- Larger randomized trials are needed to confirm these findings and define clinical benefits.
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