Effect of tourniquet application on deep vein thrombosis after total knee arthroplasty

Fukuda, Aki; Hasegawa, Masahiro; Kato, Ko; Shi, Dequan; Sudo, Akihiro; Uchida, Atsushi

doi:10.1007/s00402-006-0244-0

Cited by 105 publications

(93 citation statements)

References 31 publications

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“…Advantages of tourniquet use include improved visualization, reduced intraoperative blood loss, and enhancement of cement fixation [11,14,17,21,22,27,45,54]. Reported adverse effects of tourniquet use include reduced early knee flexion [11,14,60,62,65], increased perioperative pain [11,14,27,56], postoperative limb swelling [11,21,47], wound complications [9,12,40,41], and creation of cardiac and cerebral microemboli [16,20,[42][43][44]55].…”

Section: Discussionmentioning

confidence: 99%

“…Increased intraoperative blood loss was observed when a tourniquet was not used, but no statistical differences were found in total (intraoperative + postoperative) blood loss between the tourniquet and no-tourniquet groups. Review of the literature shows the majority of studies confirm that intraoperative blood loss is greater if a tourniquet is not used [3,11,14,17,19,22,28,29,45,49,56,58,60,65]. Reports analyzing total blood loss are conflicting with some demonstrating no differences with or without tourniquet use [1,29,49,58], whereas others demonstrate reduced [3,54] or increased [28,58] total blood loss if a tourniquet is used.…”

Section: Discussionmentioning

confidence: 99%

“…Application of a tourniquet during TKA has been frequently used to improve visualization of the operative field, decrease intraoperative blood loss [11,14,17,22,27,60,65], and improve the quality of cementation by providing a relatively bloodless operative field [21]. A 2010 analysis of current practice patterns of members of the American Association of Hip and Knee Surgeons found 95% of patients without vascular disease who underwent TKA had their procedures performed under tourniquet control [7].…”

Section: Introductionmentioning

confidence: 99%

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Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

Dennis

Kittelson

Yang

et al. 2016

Clinical Orthopaedics &Amp; Related Research

169

148

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Background Tourniquet use during total knee arthroplasty (TKA) improves visibility and reduces intraoperative blood loss. However, tourniquet use may also have a negative impact on early recovery of muscle strength and lower extremity function after TKA. Questions/purposes The purpose of this study was (1) to determine whether tourniquet use affects recovery of quadriceps strength (primary outcome) during the first 3 postoperative months; and (2) to examine the effects of tourniquet application on secondary outcomes: voluntary quadriceps activation, hamstring strength, unilateral limb balance as well as the effect on operative time and blood loss.Methods Twenty-eight patients (mean age 62 ± 6 years; 16 men) undergoing same-day bilateral TKA (56 lower extremities) were enrolled in a prospective, randomized study. Subjects were randomized to receive a tourniquetassisted knee arthroplasty on one lower extremity while the contralateral limb underwent knee arthroplasty without extended tourniquet use. In the former group, the tourniquet was inflated just before the incision was made and released after cementation; in the latter group, a tourniquet was not used (10 of 28 [36%]) or inflated only during component cementation (18 of 28 [64%]). The choice of no tourniquet or use just during cementation was based on surgeon choice, because some surgeons felt a tourniquet during cementation was necessary to achieve a dry surgical field to maximize cement fixation. A median parapatellar approach and the One or more of the authors (DAD, CCY, TMM, RHK) has received funding from Porter Adventist Hospital, during the study period, in the amount of USD 10,000 to USD 100,000. One of the authors (DAD) has or may receive payments or benefits from DePuy (Warsaw, IN, USA) in the amount of USD more than USD 1,000,001 not related to this work. One of the authors certifies that he (RHK) has or may receive payments or benefits from Stryker (Kalamazoo, MI, USA) and Innomed (Savannah, GA, USA) in the amount of USD 100,001 to USD 1,000,001 not related to this work. One of the authors (TMM) has or may receive payments or benefits from Zimmer (Warsaw, IN, USA) in the amount of less than USD 10,000 not related to this work. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.The surgeries for this study were performed at Porter Adventist Hospital, Denver, CO, USA, and the postoperative patient te...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

Dennis

Kittelson

Yang

et al. 2016

Clinical Orthopaedics &Amp; Related Research

169

148

View full text Add to dashboard Cite

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“…In the current literature, the impact of the width of a tourniquet and as a consequence the pressure expansion, is discussed controversial [3,[10][11][12][13][14] .…”

Section: Introductionmentioning

confidence: 99%

Nerve compression and pain in human volunteers with narrowvswide tourniquets

Kovar

Jaindl

Oberleitner

et al. 2015

WJO

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AIM:To assess the clinical effects and the morphological grade of nerve compression. METHODS:In a prospective single-center randomized, open study we assessed the clinical effects and the morphological grade of nerve compression during 20 min of either a silicon ring (group A) or pneumatic tourniquet (group B) placement variantly on the upper non-dominant limb in 14 healthy human volunteers. Before and during compression, the median and radial nerves were visualized in both groups by 3 Tesla MR imaging, using high resolutional (2.5 mm slice thickness) axial T2-weighted sequences. RESULTS:In group A, Visual analog pain scale was 5.4 ± 2.2 compared to results of group B, 2.9 ± 2.5, showing a significant difference (P = 0.028). FPS levels in group A were 2.6 ± 0.9 compared to levels Core tip: Nerve injury is a serious potential complication associated with clinical use of tourniquets in surgery. ORIGINAL ARTICLEIn a prospective single-center randomized, open study we assessed the clinical effects and the morphological grade of nerve compression during 20 min of either a silicon ring (group A) or pneumatic tourniquet (group B) placement variantly on the upper non-dominant limb, visualized by 3 Tesla magnetic resonance imaging, using high resolutional (2.5 mm slice thickness) axial T2-weighted sequences. Based on our results, no differences between narrow and wide tourniquets were identified. Silicon ring tourniquets can be regarded as safe for short time application.Kovar FM, Jaindl M, Oberleitner G, Endler G, Breitenseher J, Prayer D, Kasprian G, Kutscha-Lissberg F. Nerve compression and pain in human volunteers with narrow vs wide tourniquets.

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“…Some authors have advised tourniquet use to improve visualization in the surgical area and provide a bloodless field for cementing [6,16]. However, others do not recommend tourniquet use due to probable adverse affects such as nerve injury, thromboembolism, postoperative pain, and decreased muscle strength [12,21].…”

Section: Introductionmentioning

confidence: 99%

Late Tourniquet Release and Drain Clamping Reduces Postoperative Blood Loss in Total Knee Arthroplasty

Yıldız

Koca

Koçak³

et al. 2014

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Many studies have investigated the effect of tourniquet release time and closed suction drainage in total knee arthroplasty (TKA). However, controversy remains as to the advisability of preclosure tourniquet release and the advisability of closed suction drain use following total knee arthroplasty. Questions/Purposes: The aim of the study was to investigate if there is a benefit of performing tourniquet release after skin closure, along with drain clamping, for the first 6h following TKA. Methods: Ninety-six patients underwent TKA between May 2009 and April 2010. Fourteen of these were excluded because of systemic diseases and simultaneous bilateral TKA. Twenty-nine of these were excluded due to use of a patellar component and posterior cruciate ligament (PCL)-sacrificing systems. Thus, 53 patients that underwent PCL-retaining cemented TKA were reviewed retrospectively. In the control group (group C), the tourniquet was released before skin closure, an attempt at hemostasis was made, and a compressive bandage was applied. The drain was not clamped in these patients. The test group of 23 patients (group T) had tourniquet release after skin closure and after the compressive bandage was applied. The drain was clamped for the first 6h after surgery. The two groups were compared as to the amount of drained blood, postoperative change in hemoglobin, postoperative complications, and knee function. Results: We found that drained blood and hemoglobin drop were significantly lower in group T compared with group C. There was no difference regarding postoperative complications and knee function. Conclusion: We conclude that tourniquet release after skin closure and compressive dressing followed by 6h of drain clamping reduces postoperative blood loss in TKR surgery.

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Effect of tourniquet application on deep vein thrombosis after total knee arthroplasty

Cited by 105 publications

References 31 publications

Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

Nerve compression and pain in human volunteers with narrowvswide tourniquets

Late Tourniquet Release and Drain Clamping Reduces Postoperative Blood Loss in Total Knee Arthroplasty

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