Abstract: Objective To compare and explore the effects of leg elevation of blood-expelling and blood-expelling by the exsanguination band on the early clinical outcomes during total knee arthroplasty (TKA). Methods A total of 80 patients with initial TKA were selected. According to different blood-expelling methods, patients were divided into the leg elevation of blood-expelling group (n=40) and the blood-expelling by the exsanguination band group (n=40). The clinical data were recorded. The levels of hemoglobin (HGB), creatine kinase (CK), C-reactive protein (CRP), interleukin (IL) -6, tumor necrosis factor (TNF)-α and D-Dimer 1 d before operation and 1 d after operation were compared between the two groups. The visual analogue scale (VAS) and knee-joint range of motion (ROM) 1 d before operation and 1 d, 3 d, 7 d and 1 month after operation, and Hospital for Special Surgery Score (HSS) 1 d before operation and 1 d, 7 d, 1 month and 3 months after operation were compared and analyzed between the two groups. The incidences of postoperative complications were recorded in the two groups. Results There were no significant differences in general data and clinical indexes before operation between the two groups. One day after operation, the level of HGB was higher in the leg elevation of bloodexpelling group than that in the other group (P＜0.05). The levels of CRP, CK, IL-6, TNF-α and D-Dimer were lower in the leg elevation of blood-expelling group than those in the blood-expelling by the exsanguination band group (P＜0.05). The knee-joint ROM and HSS of the two groups increased with time after operation, while the VAS decreased. The knee-joint ROM was higher in the leg elevation of blood-expelling group than that in the blood-expelling by the exsanguination group on 1 d and 3 d after operation, while the VAS were lower on 1 d, 3 d, and 7 d after operation in the leg elevation of bloodexpelling group than the another group (P＜0.05). There were no significant differences for HSS between different blood-expelling methods. The incidence of lower limb swelling after operation was higher in the blood-expelling by the exsanguination band group than that in the leg elevation of blood-expelling group (P＜0.05). The occurrence of other complications between the two groups were no significant differences (P＜0.05). Conclusion During TKA, leg elevation of blood-expelling method is not only simple to operate, but also has more advantages in reducing early pain, swelling, inflammatory response, vein thrombosis and other complications, which helps patients recover quickly has higher clinical practical value.

Key words: arthroplasty, replacement, knee, tourniquets, reperfusion injury, interleukin-6, tumor necrosis factoralpha, blood-expelling