{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:24:26Z","timestamp":1785198266878,"version":"3.55.0"},"reference-count":30,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2014,4,10]],"date-time":"2014-04-10T00:00:00Z","timestamp":1397088000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2014,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Extensive blood loss after total knee arthroplasty (TKA) may be a potential problem since it leads to anaemia, increased need for transfusion and prolonged hospitalization. Aim of this study was to investigate the effects of postoperative knee flexion after TKA on blood loss and the need for transfusion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>One hundred consecutive patients undergoing primary TKA from 2012 to 2013 were randomizely divided into two groups. In one group, the knee was extended for the first 6 h after surgery, whereas in the other was flexed at 90\u00b0 for the same time. Two doses of endovenous tranexamic acid were administered in all subjects. Patients were homogeneous for all the possible confounding factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Calculated blood loss was 846 \u00b1 197 (ml) in the flexion group and 1,242 \u00b1 228 (ml) in the extension group (<jats:italic>p<\/jats:italic> &lt; 0.05). Drop of haemoglobin levels at 24 h in the study group and the control group was 1.9 \u00b1 0.8 (g\/dl) and 3.0 \u00b1 0.5 (g\/dl), respectively (<jats:italic>p<\/jats:italic> &lt; 0.01). Drop of haematocrit at 24 h was 4.5 \u00b1 0.2 (%) in the flexion group and 6.7 \u00b1 0.3 (%) in the extension group (<jats:italic>p<\/jats:italic> &lt; 0.05). Blood transfusion was necessary in 5 patients in the control group and was not necessary in any patient of the study group. Average knee flexion at day 7 was 105\u00b0 \u00b1 4\u00b0 in the flexion group and 98\u00b0 \u00b1 7\u00b0 in the extension group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Knee flexion at 90\u00b0 after TKA, associated with the intraoperative use of tranexamic, acid is an effective method to reduce blood loss and the need for blood transfusion. The routine use of the present protocol is effective in reducing social costs and length of hospitalization of TKA procedures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Prospective comparative study, Level I.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-014-2983-8","type":"journal-article","created":{"date-parts":[[2014,4,9]],"date-time":"2014-04-09T10:54:14Z","timestamp":1397040854000},"page":"1859-1864","source":"Crossref","is-referenced-by-count":20,"title":["Knee flexion after total knee arthroplasty reduces blood loss"],"prefix":"10.1002","volume":"22","author":[{"given":"Alfredo Schiavone","family":"Panni","sequence":"first","affiliation":[{"name":"Department of Medicine and Science for Health Molise University Via De Sanctis 1 Campobasso Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Cerciello","sequence":"additional","affiliation":[{"name":"Department of Medicine and Science for Health Molise University Via De Sanctis 1 Campobasso Italy"},{"name":"Via R. Zandonai 11 00135 Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Vasso","sequence":"additional","affiliation":[{"name":"Department of Medicine and Science for Health Molise University Via De Sanctis 1 Campobasso Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Del Regno","sequence":"additional","affiliation":[{"name":"Department of Medicine and Science for Health Molise University Via De Sanctis 1 Campobasso Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,4,10]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.4103\/0970\u20100358.63962"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100030\u20101247737"},{"key":"e_1_2_6_4_1","first-page":"295","article-title":"Factors affecting perioperative blood loss and transfusion rates in primary total joint arthroplasty: a prospective 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