Continuous Hemodynamic Monitoring and Goal-Directed Therapy for Optimization in Total Knee Replacement: A Prospective Observational Study

Goal-directed fluid therapy (GDT) has become an important strategy for optimizing perioperative hemodynamics by tailoring fluid administration to each patient's individual needs. In this prospective observational study, we evaluated the use of GDT guided by the non-invasive ClearSight monitoring system (Edwards Lifesciences Corporation, Irvine, CA, USA) in patients undergoing total knee arthroplasty (TKA) under spinal anesthesia. Forty patients were included and managed either with a GDT protocol or with standard fluid therapy. Hemodynamic parameters, fluid administration, and early postoperative outcomes were assessed. Patients in the GDT group received significantly less intraoperative crystalloid volume compared to controls and had a shorter stay in the post-anesthesia care unit. Moreover, the GDT group demonstrated more stable mean arterial pressure throughout the procedure. These findings suggest that continuous non-invasive hemodynamic monitoring can enhance intraoperative fluid optimization and improve immediate recovery following orthopedic surgery. Larger randomized trials are necessary to confirm these results and further define the clinical benefits of GDT in this setting.