The tourniquet in total knee arthroplasty

Wakankar, Hemant; Nicholl, J. E.; Koka, R.; D'Arcy, J.C.

doi:10.1302/0301-620x.81b1.8971

Cited by 129 publications

(108 citation statements)

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“…Like Wakankar et al [17], we found that complication rates associated with TKA were the same with or without use of a tourniquet. Harvey et al [7] found the incidence of DVT was unrelated to tourniquet use, whereas others observed an increased incidence [14].…”

Section: Discussionsupporting

confidence: 82%

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The effect of tourniquet use in total knee arthroplasty

Vandenbussche

Duranthon

Couturier

et al. 2002

International Orthopaedics

157

152

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We conducted a prospective, randomised study on primary total knee replacements to evaluate the effects of tourniquet use on total calculated blood loss using Gross formula, post-operative measured blood loss, operating time, need for blood transfusion, post-operative pain, analgesia requirement and knee flexion. Forty patients were operated on with the use of an arterial tourniquet with pressure of 350 mmHg (group A), and 40 patients without the use of a tourniquet (group B). Total calculated blood loss was significantly increased (P=0.0165) without the use of a tourniquet. There was no significant difference in measured blood loss or operating time. The median units of blood given were similar in both groups. In spite of autologous transfusions 14% of patients received additional homologous transfusions. At 6 h post-operatively pain was significantly less (P=0.0458) in group B but was similar at 24 and 48 h. There was no significant difference in analgesia requirement. The mean change in total flexion in group B was significantly better (P<0.001) at 5 days than in group A, but knee flexion was similar at 10 days and 3 months. Knee arthroplasty operations without the use of a tourniquet cause a greater blood loss but have only small benefits in the early post-operative period.Résumé Une étude prospective et randomisée a été réali-sée sur 80 arthroplasties totales du genou consécutives de première intention dans le but d'évaluer l'effet de l'utilisation du garrot pneumatique sur les pertes sanguines totales calculées selon la formule de Gross, les pertes sanguines mesurées par drainage aspiratif, la durée opératoire, la né-cessité de transfusion sanguine, la douleur post-opératoire, le besoin d'antalgique et la récupération de la flexion du genou. Quarante patients ont été opérés avec un garrot pneumatique gonflé à 350 mmg (group A), et quarante sans garrot pneumatique (group B). Les pertes sanguines totales calculées étaient plus élevées de façon significative (P=0.0165) dans le groupe B. Il n'y avait pas de différence significative entre les deux groupes sur les pertes sanguines mesurées par drainage aspiratif et la durée opératoire. Le nombre de culots globulaires nécessaire était le même dans les deux groupes. Malgré un protocole d'autotransfusion, 14% des patients ont eu une transfusion homologue complémentaire. La douleur post-opératoire était significativement moindre (P=0.0458) à la sixième heure dans le groupe B mais était identique à 24 et 48 heures. Il n'y avait pas de différence sur la consommation d'antalgique. La flexion dans le groupe B était meilleure (P<0.001) au cinquième jour que dans le groupe A, mais était identique à 10 jours et au troisième mois post-opératoire pour les deux groupes. La non-utilisation d'un garrot pneumatique apporte quelques bénéfices dans la période post-opératoire immédiate mais est responsable d'une majoration des pertes sanguines totales calculées. IntroductionDespite progress in pre-operative autologous donation, intraoperative normovolaemic haemodilution and...

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Section: Discussionsupporting

confidence: 82%

“…We used a pressure of 350 mmHg in this study; however, pressure may vary according to surgical staff. For example, studies using twice the patient's systolic blood pressure have been reported [2,14,17]. In such cases pressure is not uniform because it is governed by the individual's systolic blood pressure.…”

Section: Discussionmentioning

confidence: 99%

The effect of tourniquet use in total knee arthroplasty

Vandenbussche

Duranthon

Couturier

et al. 2002

International Orthopaedics

157

152

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“…13 The recovery of knee flexion in the early postoperative period has been shown to be significantly better when a tourniquet has not been used. 9,14,15 Skeletal muscle may be more sensitive to an ischemic condition than peripheral nerves. 16 The use of the tourniquet is considered to be a risk for nerve injury in the affected extremity.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of pain in bilateral total knee replacement with and without tourniquet; a prospective randomized control trial

Kumar

Yadav

Singh

et al. 2015

Journal of Clinical Orthopaedics and Trauma

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“…Furthermore bosentan has shown promising results in prevention of ischemic skeletal muscle necrosis [12,15,26] and tissue protection in different organs (liver, kidney, lung, heart, brain) in case of infection and sepsis [22,31,35,8]. As a result of the low incidence, larger study groups are necessary for determining specific ET-1 release kinetics in patients with wound healing disorders and early infections to indicate a prophylactic effect of ET-1 antagonists, bosentan being the most promising candidate.…”

Section: Discussionmentioning

confidence: 99%

Endothelin‐1 is secreted after total knee arthroplasty regardless of the use of a tourniquet

Matziolis

Drahn

Schröder

et al. 2005

Journal Orthopaedic Research

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Early infections and wound healing disorders after implantation of a total knee replacement occur regardless of the intraoperative use of a tourniquet. The biochemical regulatory processes responsible for the disturbances in microcirculation and thus the potential therapeutic options have yet to be elucidated. The hypothesis of the present paper was that endothelin-1 (ET-l), a mediator of microcirculation disturbances in parenchymatous organs, also is released after major operations on peripheral joints.The concentration of ET-1 in the plasma was determined preoperatively and at 10 postoperative time points (5min43h) with (group A, n = 10) and without the use of a tourniquet (group B, n = 10). The ET-1 concentration achieved its maximum 6h after opening the tourniquet, which corresponded to 3.3 times the preoperative value. Without a tourniquet, the concentration maximum (2.9 times the baseline value) was achieved already 1.5 h after the end of the operation. However, the total amount of ET-1 secreted over 24h was identical in both groups (p > 0.5).We conclude that the tissue hypoxia resulting from the use of a tourniquet modulates ET-I secretion, but that traumatization during the operation has a much stronger influence on the total amount secreted.ET-I antagonists thus should be discussed for the drug prophylaxis of wound healing disorders, regardless of the use of a tourniquet.

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The tourniquet in total knee arthroplasty

Cited by 129 publications

References 0 publications

The effect of tourniquet use in total knee arthroplasty

The effect of tourniquet use in total knee arthroplasty

Evaluation of pain in bilateral total knee replacement with and without tourniquet; a prospective randomized control trial

Endothelin‐1 is secreted after total knee arthroplasty regardless of the use of a tourniquet

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