Evidence on the use of Cruciate Retaining / substituting, patient specific instrumentation, drains, continuous passive motion, obesity as risk factor, use of tourniquet, computer navigation, tranexamic acid

1. “Strong” Evidence in the
Treatment of
Advanced OA Knee

2. Obese patients have less improvement in
outcomes with Total Knee Arthroplasty (TKA)

3. PERIARTICULAR LOCAL
ANESTHETIC
INFILTRATION
Peri-articular local anesthetic infiltration in
TKA decreases pain and reduced opioid use

4. PERIPHERAL NERVE BLOCKADE
Peripheral nerve blockade in TKA decreases
postoperative pain and opioid requirements

5. TOURNIQUET:
POSTOPERATIVE PAIN
REDUCTION
Tourniquet use in TKA increases short term post-
operative pain

6. TRANEXAMIC ACID
Tranexamic acid decreases postoperative
blood loss and reduces the necessity of
postoperative transfusions following TKA
(provided there are no contraindications to its
use)

7. CRUCIATE RETAINING
ARTHROPLASTY
No difference in outcomes/complications
between cruciate sacrificing(PS) and posterior
cruciate retaining(CR) arthroplasty designs

8. POLYETHYLENE TIBIAL
COMPONENT
No difference in outcomes between all-
polyethylene or modular tibial components in
TKA

9. PATELLAR RESURFACING:
Pain and Function
No difference in pain/function with or without
patellar resurfacing in TKA

10. CEMENTED Vs CEMENTLESS
TIBIAL COMPONENTS
No difference between tibial component fixation
that is cemented or cementless in TKA with
respect to functional outcomes, rates
of complications/reoperations

11. SURGICAL NAVIGATION
Does NOT support using Computer navigation in
TKA because there is NO difference in
outcomes/complications

12. PATIENT SPECIFIC
INSTRUMENTATION(PSI):
Pain and Function
Does NOT support using PSI compared to
conventional instrumentation for TKA because
there is no difference in pain/functional
outcomes.

13. DRAINS
Does NOT support using a drain with Total Knee
Arthroplasty (TKA) because there is no
difference in complications/outcomes

14. CONTINUOUS PASSIVE
MOTION
CPM after knee arthroplasty does NOT improve
outcomes

15. POSTOPERATIVE
MOBILIZATION: Length of
Stay
Recommends rehabilitation started on the day of
the TKA itself as it reduces length of hospital
stay

16. For more Evidence, visit,
www.orthopaedicprinciples.com

17. Modified and Adapted from the AAOS Clinical
Practice Guidelines- Latest Edition, 2016