Search Results (620)

Background/Objectives: Thrombocytopenia increases bleeding tendency and may complicate perioperative management in total knee arthroplasty (TKA), yet data on both in-hospital burden and post-discharge adverse events are limited. This study evaluated the association between preoperative platelet count and outcomes after primary TKA. Methods: In total, 3474 primary TKAs performed for osteoarthritis at a single institution (2008–2023) were retrospectively reviewed. Patients were classified as Normal, Mild, Moderate, or Severe by preoperative platelet count; the Severe group (N = 6) was excluded from comparative analyses and reported descriptively. Inverse probability of treatment weighting (IPTW) balanced baseline covariates. In-hospital outcomes were red blood cell (RBC) transfusion, intensive care unit (ICU) admission, and length of stay; follow-up outcomes were 30-day readmission, 1-year periprosthetic joint infection (PJI), and 1-year mortality. Results: After IPTW, the RBC transfusion rate rose with lower platelet count (Normal, 14.0%; Mild, 27.0%; Moderate, 32.5%; p < 0.001), and transfusion volume peaked in the Moderate group. ICU admission was more frequent (Moderate, 6.0%; Normal, 0.7%; Mild, 0.4%; p = 0.002), and length of stay increased with severity (p = 0.008). Readmission, 1-year PJI, and mortality were comparable across groups. In multivariable analysis, moderate thrombocytopenia was independently associated with RBC transfusion (adjusted odds ratio [aOR], 3.26; 95% confidence interval [CI], 1.51–6.59; p < 0.001) and ICU admission (aOR, 5.46; 95% CI, 1.37–17.41; p = 0.008), but not PJI or mortality. Conclusions: Preoperative thrombocytopenia—particularly in the mild-to-moderate range evaluated in this study—increased perioperative burden after TKA, with higher RBC transfusion and ICU utilization, but was not associated with a significant increase in major postoperative adverse events during 1-year follow-up. Even if not causally responsible, a low preoperative platelet count is a routinely available marker that may flag patients requiring closer perioperative attention. As the associated burden appears largely limited to the hospitalization period, such attentive in-hospital management may allow these patients to achieve favorable outcomes. Full article

Background/Objectives: Chronic lymphocytic leukemia (CLL), the most common leukemia in adults, predominantly affects the aging population. With improved survival from modern targeted therapies, a growing number of CLL patients are living long enough to become candidates for quality-of-life-improving procedures such as elective total knee arthroplasty (TKA). However, the impact of CLL on postoperative outcomes remains poorly understood. Methods: A retrospective cohort analysis was performed using the TriNetX Research Network. Adult patients who underwent primary TKA were identified and divided into two cohorts. CLL and non-CLL control, and 1:1 propensity score matching was performed on demographics and comorbidities. Medical complications were assessed at 30 and 90 days, and implant-related complications at 1 and 3 years postoperatively. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated. Within the CLL cohort, a Cox proportional hazards model was used to identify preoperative laboratory values, medications, and comorbid diagnoses associated with complication development. Results: After matching, 2054 patients, 1027 per cohort, were analyzed. Patients with CLL demonstrated significantly higher risks of postoperative pain at both 30 days (p < 0.001) and 90 days (p < 0.001), as well as transfusion (p = 0.035) and acute kidney injury (p = 0.036) at 90 days. At 1 year, the CLL cohort had elevated risks of periprosthetic joint infection (PJI; p = 0.015) and arthrofibrosis (p = 0.036), and these differences persisted at 3 years (PJI p = 0.033; arthrofibrosis p = 0.006). In the hazards model, preoperative hemoglobin < 8 g/dL (HR: 1.75, 95% CI: 1.27–2.41, p < 0.001), long-term anticoagulant or antiplatelet use (HR: 1.43, 95% CI: 1.13–1.80, p = 0.003), chronic kidney disease (CKD; HR: 1.28, 95% CI: 1.04–1.58, p = 0.021), and overweight/obesity (HR: 1.23, 95% CI: 1.00–1.50, p = 0.047) were independently associated with short-term complications. Chronic opioid use was found to be associated with an increased risk of long-term complications (HR: 2.80, 95% CI: 1.49–5.24, p = 0.001). Conclusions: Patients with CLL undergoing TKA had higher observed risks of both early medical and late implant-related complications. These findings may reflect the combined effects of CLL-related immune dysfunction, cytopenias, and chronic systemic inflammation, which may impair wound healing, reduce physiologic reserve, and blunt infection clearance. Identification of associated, modifiable preoperative risk factors—anemia, anticoagulant exposure, CKD, obesity, and chronic opioid use—may provide actionable targets for optimization and risk stratification. Full article

Total knee arthroplasty (TKA) is increasingly performed in older adults, a population with a growing prevalence of frailty and sarcopenia. Analgesic strategies focused mainly on pain reduction may overlook mobility, functional independence, fall prevention, and delirium risk, making motor preservation a central goal of perioperative care. This narrative review examines the anatomical basis, clinical evidence, and practical application of motor-sparing regional analgesia for older adults undergoing TKA, with emphasis on frailty, sarcopenia, and mobility-centred recovery, synthesising current evidence on established, emerging, and experimental techniques. Evidence was classified as geriatric-specific, older-enriched mixed-age, or mixed-age adult. Most technique-specific evidence derives from cohorts that included younger adults; only two small randomised trials reported cohorts composed exclusively of patients aged ≥65 years, and no regional-analgesia trial stratified outcomes by frailty or sarcopenia. A pragmatic clinical decision framework was developed to support individualised strategy selection in frail and sarcopenic patients. Current evidence supports adductor canal block combined with local infiltration analgesia as the foundation of motor-sparing analgesia after TKA; supplementary techniques such as iPACK, popliteal plexus block, genicular nerve block, and anterior femoral cutaneous nerve block may further optimise sensory coverage while preserving quadricep strength, whereas femoral nerve block produces predictable motor impairment and appears less suitable for this population. The existing literature remains largely focused on pain scores and opioid consumption, while mobility-related outcomes are infrequently reported. Direct evidence for falls, near-falls, delirium, discharge destination, functional independence, and long-term mobility remains sparse or absent. Successful analgesia after TKA should be defined not only by pain relief but by preservation of mobility and functional recovery, and future research should prioritise frailty-specific, mobility-centred outcomes. Full article

Background and Objectives: This study evaluated whether exploratory spinopelvic compensation patterns are associated with 12-month patient-reported recovery after total knee arthroplasty (TKA), with explicit separation between baseline-only prediction and contemporaneous association-based risk stratification. Materials and Methods: This retrospective single-center cohort included 700 complete cases selected from 723 primary TKA records after 23 exclusions for incomplete key radiographic alignment data and/or unavailable 12-month patient-reported outcome measures (PROMs). The primary endpoint was a strict composite MCID-based endpoint, defined as failure to achieve the prespecified minimal clinically important difference (MCID) for either the Oxford Knee Score (OKS) or WOMAC at 12 months. OKS- and WOMAC-specific MCID failures were reported as component sensitivity outcomes. K-means clustering was used to define exploratory compensation patterns rather than validated preoperative phenotypes. Predictor timing was separated into a baseline-only model and a contemporaneous model that additionally used 12-month alignment-change variables. Results: The strict composite MCID endpoint occurred in 537/700 patients (76.7%). Exploratory patterns showed increasing endpoint prevalence: Pattern A, 153/215 (71.2%); Pattern B, 195/258 (75.6%); and Pattern C, 189/227 (83.3%). The baseline-only ridge logistic model showed moderate discrimination (out-of-fold AUC 0.715, 95% CI 0.670–0.758). The contemporaneous model showed higher internal discrimination (out-of-fold AUC 0.864, 95% CI 0.834–0.894), but it included alignment changes measured in the same follow-up window as the outcome. Conclusions: Baseline-only prediction was modest, whereas stronger model performance was observed only in a contemporaneous association model. The exploratory patterns should not be interpreted as stable clinical phenotypes or used for individual-level decisions without external validation. Full article

Background: Postoperative hemoglobin (Hb) reduction reflects the physiologic extent of perioperative blood loss after total knee arthroplasty (TKA). Whereas previous studies have relied on transfusion as a binary endpoint, transfusion decisions are highly variable across institutions, obscuring the underlying hematologic trajectory. This study aimed to develop and interpret machine learning (ML) models to characterize and quantify the determinants of postoperative Hb reduction in a standardized cohort of non-transfused TKA patients. Methods: A retrospective cohort of 866 patients who underwent primary TKA under a standardized operative protocol—with identical cemented posterior-stabilized implants and uniform cementing technique—was analyzed (1 January 2014–31 March 2024). During the study period, a consistent 1 g intra-articular tranexamic acid (TXA) regimen administered through the drain was introduced and applied to a subset of patients, allowing TXA use to be modeled as a binary predictor. Four ML algorithms (Linear Regression, Random Forest, XGBoost, and Stacking Regressor) were trained using preoperative, demographic, and perioperative variables. Fivefold cross-validation assessed model performance, and SHapley Additive exPlanations (SHAP) values were used to identify influential predictors and enhance interpretability. Results: Across all ML models, preoperative Hb emerged as the strongest determinant of postoperative Hb reduction, followed by TXA use, body mass index (BMI), and platelet count. Ensemble models captured non-linear and interacting effects more effectively than linear regression. Test-set performance was modest (best R² = 0.330), consistent with the influence of unmeasured physiologic factors such as hidden blood loss, fluid dynamics, and inflammatory responses. Accordingly, the primary value of the framework lies in the exploratory and transparent assessment of determinant importance rather than in individual-level prediction. Conclusions: This study provides an interpretable, exploratory ML framework for identifying factors associated with percentage Hb reduction after TKA. Preoperative Hb was the dominant determinant, while TXA use and higher BMI were recurrently associated with smaller predicted percentage reductions. Given the modest test-set performance and the absence of external validation and clinical utility assessment, the models should not be interpreted as tools for individual-level prediction or clinical decision making. Full article

Background/Objectives: This study investigated the value of several hemogram-derived biomarkers, including SIRI, SII, PIIV, NLR, MLR, and PLR, in predicting wound complications after total knee arthroplasty (TKA). Methods: This study involved 226 patients who underwent TKA between 2018 and 2024. Preoperative hematological parameters and their derived indices (NLR, MLR, PLR, PIIV, SII, and SIRI) were analyzed. To identify the parameters that predict the risk of complications, correlation analysis, ROC-curve analysis, and logistic regression analysis were performed. Additionally, a novel risk scale, entitled “Preoperative Inflammatory Index at Total Knee Arthroplasty (TKA-PII)”, was developed using factor analysis and a reliability test. Results: Postoperative wound complications were observed in 30 patients. NLR, MLR, PIIV, SII, and SIRI values were significantly higher in those who developed complications. Correlation analysis indicated a positive relationship between these inflammatory indices and the risk of developing complications. ROC-Curve analysis revealed that SIRI had the highest discriminative performance (area under curve (AUC) = 0.720), followed closely by PIIV (AUC = 0.716) and SII (AUC = 0.704) in predicting the complication risk. Logistic regression analysis identified that SIRI was the best predictor of postoperative wound complications (Odds Ratio = 2.277, p = 0.004). Additionally, the TKA-PII scale demonstrated acceptable validity and reliability (Bartlett’s test of sphericity = 0.609, Cronbach’s alpha = 0.647). Conclusions: This study’s findings suggest that preoperative hemogram-derived inflammatory indices, particularly SIRI, could be valuable markers for predicting the risk of wound complications after TKA. Furthermore, the newly developed TKA-PII scale could be used as an easy-to-use and cost-effective tool for preoperative risk assessment in clinical practice. Full article

Total-knee arthroplasty (TKA) is associated with substantial acute postoperative pain. While the adductor canal block (ACB) is widely used to provide motor-sparing anterior knee analgesia, effective management of posterior knee pain remains an important clinical challenge. The infiltration between the popliteal artery and the capsule of the posterior knee (IPACK) block was developed to address posterior capsular pain but may be associated with technical and ergonomic limitations. More recently, the popliteal plexus block (PPB) has emerged as a novel motor-sparing alternative. This narrative review summarizes the anatomical basis, current clinical evidence, and practical considerations of combining the ACB with the PPB, with particular emphasis on its potential role as an alternative to the IPACK block within Enhanced Recovery After Surgery (ERAS) pathways. Current anatomical and early clinical evidence suggests that the PPB selectively targets the terminal articular branches around the adductor hiatus while preserving the major motor nerve trunks. Available randomized clinical trials indicate that the PPB provides analgesia comparable to IPACK while maintaining motor function, with additional practical advantages including shorter procedural time and, in individual studies, reduced postoperative opioid consumption and postoperative nausea. Overall, the combined ACB and PPB approach appears to be a promising motor-sparing strategy for perioperative analgesia after TKA. However, the current evidence is derived predominantly from cadaveric studies, early-phase randomized trials, and single-center clinical investigations. Therefore, larger multicenter studies with longer follow-ups are needed to establish its long-term efficacy, safety, and role relative to the established IPACK technique. Full article

Background/Objectives: Commercial wearables are increasingly used after total hip and knee arthroplasty (THA/TKA) to record activity and gait outside the clinic and may help tailor recovery pathways. We reviewed the evidence on commercial devices, digital phenotyping, and data-informed rehabilitation after arthroplasty. Methods: We performed a structured narrative search of PubMed and Google Scholar. Of 916 records, 63 duplicates were removed, 853 were screened, 245 full texts were assessed, and 76 publications were included. Findings were synthesized thematically; no formal risk-of-bias assessment or evidence grading was undertaken. Results: Recovery differed by outcome and procedure. PROMs commonly improved within 1–3 months, while gait-quality measures recovered over about 7–13 weeks after THA and 13–24 weeks after TKA. Frequency-domain gait features, sample entropy, and machine-learning models provided information beyond step counts. Tracker-based interventions most consistently increased postoperative steps when introduced early and combined with behavior-change support, while digital rehabilitation was generally non-inferior to conventional rehabilitation. Wrist-worn consumer devices remained inaccurate with gait aids, compliance definitions varied, and higher step counts did not consistently correspond to better PROMs. Conclusions: Commercial wearables already support phenotyping and remote follow-up of individual recovery trajectories, but evidence for fully adaptive rehabilitation remains limited. Full article

Background/Objectives: Total knee arthroplasty (TKA) is the standard surgical treatment for end-stage knee osteoarthritis (KOA); however, restoration of normal gait biomechanics remains an important challenge. Objective assessment of gait recovery may provide valuable information beyond conventional clinical outcome measures. This study aimed to evaluate changes in spatiotemporal gait parameters, symmetry restoration, and functional recovery during the first year following primary TKA, and to identify predictors of postoperative gait performance. Methods: A prospective longitudinal cohort study was conducted in 150 patients undergoing primary unilateral TKA for end-stage KOA. Spatiotemporal gait parameters, symmetry-related variables, and functional outcomes were assessed preoperatively and at 3, 6, and 12 months postoperatively. Gait analysis included walking speed, step length, cadence, stance phase symmetry, symmetry index (SI), loading asymmetry, and single-limb support time. Functional evaluation included the Timed Up and Go (TUG) test, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Knee Society Score (KSS). Repeated-measures analysis of variance (ANOVA), Pearson correlation analysis, and multivariate linear regression were performed. Results: Significant improvements were observed in all gait and functional parameters throughout follow-up (all p < 0.001). Walking speed increased from 0.84 ± 0.16 m/s preoperatively to 1.21 ± 0.18 m/s at 12 months, while step length increased from 49.8 ± 7.4 cm to 64.0 ± 6.4 cm and cadence from 91 ± 10 to 108 ± 8 steps/min. SI improved from 73 ± 11% to 93 ± 6%, whereas loading asymmetry decreased from 18.2 ± 6.1% to 4.8 ± 2.3%. Walking speed demonstrated strong correlations with WOMAC score (r = −0.74, p < 0.001) and TUG performance (r = −0.79, p < 0.001). Multivariate regression analysis identified preoperative walking speed (β = 0.47, p < 0.001) as the strongest predictor of postoperative gait recovery, while age and body mass index (BMI) were significant negative predictors. Conclusions: Patients undergoing primary TKA demonstrated substantial improvements in gait biomechanics, symmetry restoration, and functional performance during the first postoperative year. Objective gait assessment was strongly associated with clinical outcomes and may facilitate identification of patients at risk of delayed recovery. Incorporating quantitative gait analysis into postoperative evaluation may support individualized rehabilitation strategies aimed at optimizing functional outcomes following TKA. Full article

Background/objectives: Evidence on gait and postural recovery after robotically assisted total knee arthroplasty (raTKA), particularly with the ROSA system, remains limited. This study compared early gait, postural, functional, and patient-reported outcomes (PROMs) between ROSA raTKA and manual TKA (mTKA), with PROMs also assessed at final follow-up. Methods: This comparative cohort study included primary TKA patients treated by a single senior surgeon using the same implant and alignment strategy. Patients underwent either ROSA raTKA or mTKA. At three months, a senior physiotherapist assessed quadricep and tibialis anterior maximum voluntary isometric strength (MVIS), centre-of-mass (CoM) kinematics, lower-limb weight distribution, timed-up-and-go (TUG), range of motion (ROM), KOOS Pain, activities of daily living (ADL), and quality of life (QoL). The same KOOS domains were compared at final follow-up. Results: Seventy primary TKAs were included: 46 raTKAs and 24 mTKAs. No intraoperative complications occurred. Groups were comparable for age, BMI, sex, grip strength, and preoperative KOOS. At three months, no significant differences were found in quadricep MVIS (p = 0.257), tibialis anterior MVIS (p = 0.327), CoM kinematics (p = 0.066), weight distribution (p = 0.189), TUG (p = 0.599), ROM (p = 0.165), or KOOS domains. At final follow-up, KOOS-ADL (p = 0.041) and QoL (p = 0.032) were better in the raTKA group, but after Holm–Bonferroni correction, they were no longer significant (QoL, p = 0.384; ADL, p = 0.451). Conclusions: ROSA raTKA showed comparable early gait and postural recovery to mTKA. The marginal differences in KOOS domains are exploratory, as they were no longer significant after multiple-comparisons correction. Full article

Background/Objectives: Total Knee Arthroplasty (TKA) is the gold-standard treatment for end-stage knee osteoarthritis. After surgery, the natural onset of edema and pain usually influences the early functional recovery. Manual Lymphatic Drainage (MLD) has been proposed as a possible adjunct rehabilitation strategy in the immediate management of the operated joint. This review aimed to assess the effectiveness of MLD during early rehabilitation after TKA. Methods: Searches were conducted in PubMed, Embase, CINAHL, and Google Scholar up to June 2025. Eligible studies were randomized controlled trials (RCTs) comparing MLD with non-MLD interventions (standard physiotherapy, Kinesiotaping, and negative-pressure devices). An exploratory meta-analysis using a random-effects model was performed. The primary outcome was postoperative edema reduction; secondary outcomes were the effects on pain and range of motion (ROM). Results: Eight RCTs (n = 463 participants) met the inclusion criteria. Edema data were insufficient for reliable quantitative synthesis (two poolable studies; SMD = −1.08 and +0.20; I² = 78.1%). MLD did not yield consistent improvements in AROM (SMD = 0.15; 95% CI: −0.08 to 0.37; I² = 0.0%) or pain. Two studies reported modest, short-lived benefits in the first postoperative days. No treatment-related adverse events were reported. Conclusions: Available evidence does not support the routine use of MLD as a primary intervention after TKA. Owing to its excellent safety profile, MLD may be considered selectively within a multimodal rehabilitation program as an adjunctive comfort-enhancing intervention, particularly for patients with low exercise tolerance. Further high-quality RCTs with standardized protocols are needed. Full article

Background/Objectives: Total knee arthroplasty (TKA) relieves pain and restores function for most patients with end-stage knee disease; yet, a clinically important minority are left with persistent pain, stiffness or both despite well-fixed, well-aligned implants. These “hidden failures” are poorly captured by implant survivorship but drive disability, dissatisfaction and disproportionate cost—stiff knees incur roughly 1.5–7.5 times the two-year treatment costs of non-stiff knees. This review integrates three usually separate studies within one phenotype-based framework. Methods: A structured comprehensive narrative review and thematic synthesis was undertaken; PubMed/MEDLINE, Web of Science and Google Scholar were searched between 30 October 2025 and 1 May 2026, identifying 467 records, of which 239 met the eligibility criteria and informed the synthesis. Results: Clinically meaningful chronic pain affects roughly 10–30% of recipients and stiffness approximately 1–7%, with high-impact chronic pain persisting in about one-in-five and neuropathic features in a third to a half of those affected. Contemporary dissatisfaction estimates appear closer to 7–14% than the historical “one-in-five” paradigm, with persistent pain and stiffness the dominant drivers of residual dissatisfaction. Symptoms arise from interacting mechanical, fibrotic, infective, neuropathic, central and psychosocial mechanisms. Six practical phenotypes are proposed—pain-dominant with preserved motion, stiffness-dominant, combined stiff-and-painful, neuropathic-dominant, centrally sensitized, and arthrofibrosis with true mechanical block—and diagnosis, prevention and management are organized around them, spanning risk stratification, surgical technique, manipulation under anesthesia (mean gains ~30–47°, ~6% failure), arthrolysis, revision and multidisciplinary pain care. Conclusions: Chronic pain and stiffness are the quiet arithmetic of arthroplasty success—rare on the survivorship curve, common in the clinic. Matching treatment to phenotype and reserving the operating theater for a knee with a mechanical fault to fix rather than a nervous system to calm, offers the clearest path from a technically successful operation to a genuinely successful recovery. Full article

Purpose: Sarcopenia has emerged as a potential prognostic factor for postoperative complications, functional recovery, patient-reported outcomes, and healthcare costs in patients undergoing total knee arthroplasty (TKA). This systematic review aimed to evaluate its impact on these outcomes following primary TKA. Methods: A systematic review was conducted according to PRISMA guidelines and prospectively registered in PROSPERO (CRD420261320013). PubMed/MEDLINE, EMBASE, and Cochrane Library were searched up to 1 December 2025. Comparative clinical studies including sarcopenic and non-sarcopenic patients undergoing primary TKA and reporting postoperative outcomes were included. Methodological quality was assessed using the MINORS tool. Due to heterogeneity in study design, diagnostic criteria, and outcome measures, a narrative synthesis was performed. Results: Nine studies including more than 93,000 patients were analyzed. Sarcopenia prevalence ranged from 7.7% to 25%. Sarcopenic patients demonstrated higher rates of postoperative complications, including medical events, blood transfusion, falls, fractures, reoperations, and implant-related complications. Functional recovery was delayed, particularly in patients with sarcopenic obesity, with slower improvements in range of motion and gait speed. Although both groups improved after TKA, short- to mid-term patient-reported outcomes were often inferior in sarcopenic patients, while long-term differences were less consistent. Sarcopenia was also associated with longer hospital stay and increased healthcare costs. Conclusions: Sarcopenia is associated with worse postoperative outcomes following primary TKA and may represent a modifiable risk factor for perioperative optimization. Full article

Home-based rehabilitation after total knee arthroplasty (TKA) provides patients with the possibility of self-directed training under limited professional supervision, but its actual effect depends on whether patients can perceive, regulate, and complete lower-limb rehabilitation movements by themselves. This study explored a PSE-based auditory–motor mapping approach that translates lower-limb movement information into perceivable auditory cues to support patients’ perception and regulation of movement states. A design-oriented feasibility research process was adopted, including semi-structured interviews, non-participatory observation, thematic analysis, and a within-subject counterbalanced experiment. Joint-angle changes, movement phases, and effort-related movement information were mapped to pitch, rhythm, and loudness cues. In the experimental phase, a web-based functional prototype was used. Fifteen participants with knee pain performed three typical lower-limb training exercises in a simulated rehabilitation scenario, and auditory-cued and non-cued conditions were compared. The results indicated more favourable immediate movement-execution indicators and short-term subjective interaction outcomes under the auditory-cued condition. The Function-Behaviour-Structure framework was further applied to translate the preliminary interaction findings into a conceptual home-based rehabilitation interaction device. These findings provide preliminary support for exploring PSE-based auditory cueing in home rehabilitation interaction design, while further evaluation with actual post-TKA patients and real home-use contexts is still needed. Full article

Background: Tourniquet use during total knee arthroplasty (TKA) improves surgical visualization and limits blood loss but may also trigger ischemia–reperfusion-related hemodynamic instability. This study investigated coagulation and inflammatory responses after tourniquet release and their association with perioperative hemodynamic instability. Methods: This prospective observational cohort study included 22 patients aged 65–90 years undergoing unilateral TKA. Hemodynamic parameters, coagulation markers (D-dimer, INR, APTT), and inflammatory markers were measured at predefined perioperative time points. Hemodynamic instability was assessed using the modified shock index (MSI = HR/MAP). Non-parametric statistical analyses were performed. Results: The D-dimer and INR increased significantly after tourniquet release and remained elevated at 24 h (p < 0.001). APTT prolongation was transient (p = 0.001). The NLR and SII increased both early and late, whereas CRP showed a delayed rise. Δ analysis demonstrated temporal changes in coagulation parameters; however, no significant between-group differences according to MSI status were identified. Although ΔPeak IL-6 was higher in the unstable group, the difference was not statistically significant (p = 0.097). ROC analysis demonstrated moderate discriminative performance for ΔPeak IL-6 (AUC = 0.747), whereas the NLR (AUC = 0.471), SII (AUC = 0.529), and CAI (AUC = 0.482) showed poor predictive performance for hemodynamic instability. Conclusions: Tourniquet release induces significant coagulation and inflammatory responses following total knee arthroplasty. Although no definitive biomarker of hemodynamic instability was identified, ΔPeak IL-6 showed a trend toward association with instability and may merit further investigation. These findings suggest a possible interaction between inflammatory and coagulation pathways after tourniquet release and should be validated in larger prospective studies. Full article