2.1. Operation Procedure
postoperative pain, knee flexion, depressed
OSTEOPHYTES, STERILE
All the surgeries were performed by the hospital’s same senior orthopedic surgeon in a laminar flow-embedded operating room with a standard orthopedic operating table. After spinal anesthesia application, the patient was placed in a supine position. In the tourniquet group, the tourniquet was inflated during knee flexion (45° flexion). After the application of the Esmarch bandage, the pressure was balanced (100 mmHg higher than the patient’s synchronous systolic blood pressure), and after wound closure, the tourniquet was depressed. After sterile dressing and draping, the surgery began with a 10 to 12 cm anterior midline skin incision, followed by a medial parapatellar capsule incision. After resection of the osteophytes and soft tissue debridement, the knee was flexed as much as possible, preventing the patellar tendon from being ruptured iatrogenically. After bony resections of both the femur and tibia using gap-balancing techniques, both bones were positioned perpendicular to the mechanical axis. None of the patellae resurfaced, but all the patellar surfaces underwent patellar resection arthroplasty with electrocautery. The implants used were posterior cruciate ligament-sacrifying and inserts were mobile (NexGen, Complete Knee Solution, Zimmer, Warsaw, IN, USA). All the implants were cemented. Prior to their cementation, the bone–implant interfaces were dried thoroughly and carefully with a gauze and suction in both groups. After the adaption of the implants, some time was spent waiting for the cement to become rigid, and the layers were closed in the reverse order of their opening, but at the same position (45° knee flexion) to remove the tension when closed in full extension. In both groups, a drain was used and removed after 24 h. In the tourniquet group, the tourniquets were deflated after skin closure.The same intraoperative and postoperative protocols were followed for administering spinal anesthesia, anti-inflammatory drugs, and opioids, and for postoperative pain control and the use of antithrombotic and antibiotic prophylaxis agents.Low-molecular-weight heparin treatment was started 12 h postoperatively and continued for 30 days. Antibiotic prophylaxis was started with a first-generation cephalosporin (4 × 1 g) 1 h before the operation and continued for the next 24 h. Postoperative rehabilitation comprising passive ROM on the continuous passive motion device was started on the first postoperative day, and the patient was mobilized and allowed to engage in full-weight-bearing activities with the help of a walker on the same day. Ladder exercises were started on the second postoperative day. All the exercises were continued until the patient’s discharge, and after discharge, walking and ladder exercises were continued up to the 8th week.