On-Table Parameters to Watch for in Knee Arthroplasty - A Retrospective Analysis of Intraoperative Factors

Background: Total knee replacement (TKR) is done for severe degenerative arthritis of the knee joint, with the increasing number of the cases in developing countries to undergo TKR. There is an increase in economic burden in patients who go through these procedures in terms of surgery cost, implant cost and the cost of stay in hospitals, the latter being the most common variation. Various preoperative, intraoperative and postoperative factors decide the length of hospital stay and the economic burden in patients. The aim of our study was to determine all intraoperative parameters which are responsible for increased stay in hospital leading to increased cost burden in patients and ways to reduce the hospital stay by optimizing the patients preoperatively and to effectively manage them intra-operatively, so as to reduce the length of stay but still providing best of care to the patients. Material and methods: This study was done in our institute. It's a retrospective study done in 1022 patients who underwent elective total knee replacement for arthritis of knee joint and fractures that may need TKR. Various intraoperative parameters have been studied in this study such as surgery time, intraoperative blood loss, intraoperative blood transfusion and types of anesthesia and its effect on the length of stay of the patients in terms of economic burden. Results: We looked into the intraoperative parameters during total knee replacement and found that all these parameters have a significant role to alter the duration of hospital stay. Conclusion: Our study concluded that most of the intraoperative parameters responsible for total knee replacement are non-modifiable as one cannot predict the intraoperative complication which can lead to increased surgery time which ultimately leads to increased intraoperative blood loss and need for intraoperative blood transfusion. Type of anesthesia given at the time of surgery was also responsible for the increase in length of stay. No surgery is free of complications and so surgeons should be mentally prepared for all the events. Better preoperative optimization of patients and preoperative planning may reduce these events.