Optimizing surgical field visualization in total knee arthroplasty: a randomized controlled trial comparing esmarch bandages and simple leg elevation.

Background: This prospective randomized controlled study explores the effectiveness of two exsanguination techniques in total knee arthroplasty (TKA), comparing Esmarch bandages and simple leg elevation concerning surgical field visualization, intra-operative metrics, and post-operative outcomes.

Methods: Patients who underwent primary unilateral TKA (n = 100) were randomized and equally divided into the Esmarch bandage (EM group) and simple leg elevation (LE group) groups. Surgical field visualization was assessed using the Fromme-Boezaart grading scale. The operative time, intra-operative blood loss, total blood loss, post-operative pain, leg swelling, and post-operative complications were also assessed.

Results: Surgical field visualization was significantly better in the EM group for all steps except for wound closure. The overall surgical field scales were 1.16 ± 0.29 and 1.46 ± 0.34 in the EM and LE groups, respectively (p < 0.001). The operative time and intra-operative blood loss were not significantly different between the two groups. Post-operative pain levels on days 1 and 3, and total blood loss were comparable between the groups. The knee circumference significantly increased in the EM group compared to the LE group (4.6% vs. 2.9%; p = 0.04).

Conclusions: Although Esmarch bandages enhance surgical field visualization, they do not reduce operative time or blood loss compared to simple leg elevation. However, the improved visualization is associated with increased post-operative knee swelling.

Trial Registration: Clinical Trials Gov (NCT03989648) (18/06/2019).