Is cement penetration in TKR reduced by not using a tourniquet during cementation? A single blinded, randomized trial

Vertullo, Christopher J.; Manickaraj, Nagarajan

doi:10.1177/2309499016684323

Cited by 24 publications

(15 citation statements)

References 35 publications

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“…In addition, tourniquet use facilitates preparation of drier bone surfaces for cementing, which can theoretically affect cement penetration into periprosthetic bone [23], thereby enhancing initial and long-term fixation and survivorship [23,47,48]. This rationale can influence the surgeon's decision to use a tourniquet; however, studies have failed to show differences in tibial cement penetration or long-term implant survival attributable to tourniquet use in TKA [14,49,50].…”

Section: Discussionmentioning

confidence: 99%

Tourniquet and tranexamic acid use in total knee arthroplasty

et al. 2020

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Background: There is no consensus on how tourniquet and tranexamic acid (TXA) use in total knee arthroplasty (TKA) affect blood transfusion rates and total blood loss. We compared outcome measures and transfusion rates after TKA, with and without the use of tourniquet and TXA. Methods: A retrospective study of 477 consecutive patients undergoing primary TKA between 2008 and 2013 was performed. There were 243 in the tourniquet-assisted (TA) and 234 in the tourniquetunassisted (TU) group. Operative times, hemoglobin levels, blood transfusion rates, complications, and length of stay were assessed. Subanalysis was performed on those patients receiving and not receiving TXA within the TU group. Results: Mean operative duration was 66.4 minutes in the TA group and 87.5 minutes in the TU group (P < .0001). Mean postoperative drop in hemoglobin was greater in TU group (3.1 g/dL vs 2.8 g/dL, P ¼ .002). The transfusion rate was 9.5% in TA compared with 11.5% in TU patients (P ¼ .46) with comparable mean units transfused (2.6 vs 2.2, P ¼ .30). There was no difference in wound infection (P ¼ .82) and total complication rates (P ¼ .27) between groups. Those patients given TXA had a lower hemoglobin drop (2.6 g/ dL vs 3.3 g/dL, P ¼ .04) with similar transfusion (13.3% vs 11%, P ¼ .61) and complication (P ¼ .95) rates. Conclusions: TU TKA had a greater operative duration and postoperative drop in hemoglobin than TA TKA. However, transfusion rates were similar between groups. TXA use reduced the operative decrease in hemoglobin with no effect on complication or transfusion rates.

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Section: Discussionmentioning

confidence: 99%

Tourniquet and tranexamic acid use in total knee arthroplasty

et al. 2020

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“…Complications were reported in three studies [15,17,22]. The number of patients with minor complications increased following tourniquet use.…”

Section: Complicationsmentioning

confidence: 99%

“…Some studies have found that the use of tourniquets causes an increase in cement penetration due to loss of the blood and fat in the cancellous bone during bonding [13,14]. However, there are also studies that suggest that tourniquet use does not affect cement mantle penetration [15][16][17][18], further clouding the issue. It is unclear whether the use of tourniquets can increase the thickness of the bone cement around the tibial prosthesis and indirectly improve the stability and durability of the prosthesis.…”

Section: Introductionmentioning

confidence: 99%

Does tourniquet use affect the periprosthetic bone cement penetration in total knee arthroplasty? A meta-analysis

Song

Jin

et al. 2020

J Orthop Surg Res

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Background A tourniquet is a device commonly used to control massive hemorrhage during knee replacement surgery. However, the question remains whether the use of tourniquets affects the permeability of the bone cement around the knee prosthesis. Moreover, the long-term effects and stability of the knee prosthesis are still debatable. The aim of this study was to examine whether the use of a tourniquet increases the thickness of the cement mantle and affects the postoperative blood loss and pain during primary total knee arthroplasty (TKA) using meta-analysis. Methods We searched the Cochrane Central Library, MEDLINE, Embase, PubMed, CNKI, and Wang Fang databases for randomized controlled trials (RCTs) on primary TKA, from inception to November 2019. All RCTs in primary TKA with and without a tourniquet were included. The meta-analysis was conducted using RevMan 5.2 software. Results A total of eight RCTs (677 knees) were analyzed. We found no significant difference in the age and sex of the patients. The results showed that the application of tourniquet affects the thickness of the bone cement around the tibial prosthesis (WMD = 0.16, 95%CI = 0.11 to 0.21, p < 0.00001). However, in our study, there was no significant difference in postoperative blood loss between the two groups was observed (WMD = 12.07, 95%CI = − 78.63 to 102.77, p = 0.79). The use of an intraoperative tourniquet can increase the intensity of postoperative pain (WMD = 1.34, 95%, CI = 0.32 to 2.36, p = 0.01). Conclusions Tourniquet application increases the thickness of the bone cement around the prosthesis and may thus increase the stability and durability of the prosthesis after TKA. The application of an intraoperative tourniquet can increase the intensity of postoperative pain.

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“…20 Vertullo et al evaluated radiographic evidence for cement penetration in the immediate post-operative period. 39 They also found no significant difference between the tourniquet and no tourniquet groups. Although it is beyond the scope of this study to expand upon the numerous complications associated with the use of a tourniquet, they are worth briefly mentioning.…”

Section: Discussionmentioning

confidence: 91%

A comparison of blood loss and the need for transfusion following primary total knee replacement with or without the use of a tourniquet

et al. 2018

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INTRODUCTIONTotal knee replacement (TKR) is an extremely common operation with nearly 70,000 performed each year in the UK. 1 With an increasingly ageing population, demands for this surgical intervention are likely to rise. TKR has traditionally been carried out with the use of a tourniquet placed in a proximal thigh position and set to a pressure of 300 mmhg for either the entirety or part of the operation. The benefits of using a tourniquet are often quoted as a reduction in blood loss during the operation and a reduction in the operative time by allowing the surgeon a bloodless operative field.2,3 It is also thought to improve the cementing technique during prosthetic implantation as the bloodless field permits better penetration of cement into bone.4,5 However these presumptions have been questioned. ABSTRACTBackground: Primary total knee replacement (TKR) has traditionally been carried out with the use of a tourniquet. More recent trends towards performing the surgery without a tourniquet have had some support in the literature and may improve patient recovery. Methods: A retrospective cohort of 198 consecutive primary TKRs from our institution were identified and analysed, 52 used a tourniquet and 146 did not. All TKRs also utilised a standardised interventions protocol including withholding of anticoagulants and antiplatelet medications, topical adrenaline injection, and both IV and topical tranexamic acid. Outcomes measured were estimated intra-operative blood loss, overall blood loss through comparison of pre and post-operative haemoglobin laboratory values, and the need for post-operative blood transfusion. Results: Analysis demonstrated a statistically significant reduction in estimated intra-operative blood loss when a tourniquet was used (p<0.001). However, overall blood loss indicated by the haemoglobin drop after surgery was not significantly affected by tourniquet use (p=0.342). Transfusion requirements were also similar among the groups (4.8% vs. 5.8%) and no tendency was suggested towards an increased rate of transfusion in the non-tourniquet group. Conclusions: Our study shows that although estimated intra-operative blood loss is increased without a tourniquet, total blood loss as measured by haemoglobin levels is no different for primary TKRs that use a tourniquet and those that do not. Furthermore there is no difference in post-operative blood transfusion rates. It is our hope that this study will add to the body of evidence for surgeons to consider no longer using a tourniquet for primary TKR.

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Is cement penetration in TKR reduced by not using a tourniquet during cementation? A single blinded, randomized trial

Cited by 24 publications

References 35 publications

Tourniquet and tranexamic acid use in total knee arthroplasty

Tourniquet and tranexamic acid use in total knee arthroplasty

Does tourniquet use affect the periprosthetic bone cement penetration in total knee arthroplasty? A meta-analysis

A comparison of blood loss and the need for transfusion following primary total knee replacement with or without the use of a tourniquet

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