Priority 18 from the Revision Knee Replacement PSP

UNCERTAINTY: What are the best non-surgical treatments around the time of revision knee surgery to improve outcomes (e.g. reducing bleeding, improving wound care)? (JLA PSP Priority 18)
Overall ranking	18
JLA question ID	0093/18
Explanatory note	What else can be done in addition to the revision knee operation itself, to ensure the best possible outcome for patients? This might include strategies ,including but not limited to pharmacological interventions or dressing options, to optimise all elements related to recovery following knee surgery?
Evidence	1. Newman, J.M., et al., Use of Closed Incisional Negative Pressure Wound Therapy After Revision Total Hip and Knee Arthroplasty in Patients at High Risk for Infection: A Prospective, Randomized Clinical Trial. The Journal of arthroplasty, 2019. 34(3): p. 554-559. e1. 2. Romanò, C.L., et al., Does a thrombin-based topical haemostatic agent reduce blood loss and transfusion requirements after total knee revision surgery? A randomized, controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy, 2015. 23(11): p. 3337-3342. 3. Yuan, X., et al., Synergistic effects of intravenous and intra‐articular tranexamic acid on reducing hemoglobin loss in revision total knee arthroplasty: a prospective, randomized, controlled study. Transfusion, 2018. 58(4): p. 982-988.
Health Research Classification System category	Musculoskeletal

Extra information provided by this PSP
Original uncertainty examples	Do negative pressure dressings reduce early wound complications following revision total knee replacement. ~ Should ERAS (ENHANCED RECOVERY AFTER SURGERY) be tested in these patients (& indeed all TKR patients) ~ Does effective perioperative analgesia improve long-term outcome measures after revision surgery? ~ What measures can be undertaken to prevent/reduce the risk perioperative comorbidity?
Submitted by	See data spreadsheet on JLA website

PSP information
PSP unique ID	0093
PSP name	Revision Knee Replacement
Total number of uncertainties identified by this PSP.	32 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	21 May 2019