The influence of a half-course tourniquet strategy on peri-operative blood loss and early functional recovery in primary total knee arthroplasty

Chen, Sen; Li, Jianping; Peng, Hao; Zhou, Jianlin; Fang, Hongsong; Zheng, Huifeng

doi:10.1007/s00264-013-2177-x

Cited by 53 publications

(60 citation statements)

References 32 publications

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“…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%

“…Numerous reports have found lower levels of pain when a tourniquet is not used [1,11,14,27,56]. Others have observed pain is greater with higher tourniquet inflation pressure [59,63].…”

Section: Discussionmentioning

confidence: 99%

“…Small increments (2°-58) of higher knee flexion mean values, likely of no clinical significance, were observed without tourniquet use at all testing intervals (preoperative until 3 months postoperatively). Most comparative reviews of tourniquet versus no-tourniquet use demonstrate superior knee flexion, especially in the first month after TKA, when a tourniquet was not used [11,14,60,62,65]. However, the improved knee flexion is not always maintained at longerterm followup evaluation [14,60].…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…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%

“…Numerous reports have found lower levels of pain when a tourniquet is not used [1,11,14,27,56]. Others have observed pain is greater with higher tourniquet inflation pressure [59,63].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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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More pain and slower functional recovery when a tourniquet is used during total knee arthroplasty

Liu

Zeng

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose Although a tourniquet can effectively control intraoperative blood loss and offer clear surgical field in total knee arthroplasty (TKA), its optimal usage has been controversial. The aim of this research was to perform a systematic review and meta‐analysis to compare and explore the best application of a tourniquet in TKA. Methods MEDLINE, PubMed, EMBASE, the Cochrane Library, Wanfang database, and Web of Science were searched for randomized controlled trials (RCTs) comparing the four different strategies of tourniquet application in TKA. In Group I, a tourniquet was not used and was called the non‐tourniquet (NT) group. In Group II, a tourniquet was only used during the cementation of implants and was called the specific duration tourniquet (SDT) group. In Group III, the tourniquet was only released before wound closure to control the bleeding sources and was called the majority duration tourniquet (MDT) group. In Group IV, a tourniquet was used throughout the procedure, from skin incision to wound closure and was called the whole duration tourniquet (WDT) group. Results Forty‐six RCTs were included in this systematic review and meta‐analysis. In a comparison between the NT and WDT groups (25 RCTs), intraoperative blood loss (IBL) (P = 0.0001) and range of motion (ROM) (P = 0.0001) were significantly increased in the NT group, while the visual analog score (VAS) (P = 0.0001), rate of deep vein thrombosis (DVT) (P = 0.01), and all complications (AC) (P = 0.0001) were significantly decreased in the NT group. In a comparison between the SDT and WDT groups (10 RCTs), IBL (P = 0.0001), TBL (P = 0.009), and ROM (P = 0.0001) were significantly increased in the SDT group, while thigh pain (P = 0.04) and the rate of DVT (P = 0.03) were significantly decreased in the SDT group. There were no significant differences between the MDT and WDT groups (12 RCTs) except for the rate of all complications (P = 0.01). Conclusion Despite the decrease in IBL with a tourniquet, no difference was found in TBL. In conclusion, not using a tourniquet or only using it during the cementation of implants was preferable based on the faster functional recovery, lower rate of DVTs and complications compared with using a tourniquet throughout the TKA procedure. Level of evidence I.

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No effect of tourniquet in primary total knee arthroplasty on muscle strength, functional outcome, patient satisfaction and health status: a randomized clinical trial

Jawhar

Skeirek

Stetzelberger

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose Tourniquet use during primary total knee arthroplasty (TKA) may negatively impact the early postoperative functional recovery due to molecular effects of ischaemia. The hypothesis of the present study was that primary TKA without a tourniquet positively influences the postoperative muscle strength, functional outcome, patient satisfaction and health status. Methods The monocentric, randomized, controlled trial included a total of 99 patients scheduled to undergo primary TKA (ClinicalTrials.gov NCT02475603). The patients were randomly assigned to the tourniquet (n = 50) or non‐tourniquet (n = 49) group after receiving a written informed consent. As primary outcome parameter, the functional outcome, patient expectation/satisfaction and the health status were assessed preoperatively, 6 weeks, 6 months postoperatively using Oxford knee score, WOMAC score, Mancuso score, EQ‐5D index, EQ‐VAS, anxiety score, depression score, hospital anxiety and depression scale, respectively. Additionally, a rope pulley isokinetic system (Moflex, Recotec/Bernina, Switzerland) was applied to quantify the muscle strength preoperatively, 1 week, 6 weeks and 6 months postoperatively. Results No difference in any of the outcome parameters could be observed between the groups at all time points after TKA (n.s.). Also the isokinetic muscle strength of the knee joint as quantified by concentric/eccentric peak force (N), workload (J), total workload (J) and power (W) did not reveal statistically significant differences between the groups and time points. However, in both groups improved results were found with respect to the functional outcome, patient satisfaction, health status and isokinetic muscle strength up to 6 months postoperatively. Conclusions The application of the tourniquet did not affect the isokinetic muscle strength, the functional outcome, the patient satisfaction and the health status following primary TKA. However, with and without tourniquet use, the level of the knee functionality, the patient satisfaction as well as the health status improved significantly. Level of evidence I.

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The influence of a half-course tourniquet strategy on peri-operative blood loss and early functional recovery in primary total knee arthroplasty

Abstract: The half-course tourniquet strategy could decrease the total peri-operative blood loss in primary total knee arthroplasty. It was beneficial in helping patients to achieve earlier functional recovery by improving the pain experience and limb swelling early in the post-operative period.

Cited by 53 publications

References 32 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

More pain and slower functional recovery when a tourniquet is used during total knee arthroplasty

No effect of tourniquet in primary total knee arthroplasty on muscle strength, functional outcome, patient satisfaction and health status: a randomized clinical trial

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