Timing of Tourniquet Release in Knee Arthroplasty

Rama, Krishna Reddi Boddu Siva; Apsingi, Sunil; Poovali, Sharmila; Jetti, Anand

doi:10.2106/jbjs.f.00497

Cited by 79 publications

(49 citation statements)

References 48 publications

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“…Consequently, they recommended that the tourniquet should be released after wound closure and that a compressive dressing should be applied [16] . Moreover, on the same subject, a meta-analysis of randomized controlled trials by Rama et al [17] in 2007, indicated that early tourniquet release for hemostasis increases blood loss, but also decreases the risk of regional postoperative complications (wound complications, symptomatic deep venous thrombosis and knee stiffness requiring manipulation) and the risk of reoperation. The first high-quality study that we noted in the last decade concerning the dilemma about the use of a tourniquet or not is the prospective randomized trial of Li et al [18] in 2009.…”

Section: Is It Necessary To Use a Tourniquet?mentioning

confidence: 99%

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Common controversies in total knee replacement surgery: Current evidence

Nikolaou¹

2014

WJO

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Total knee replacement (TKR) is a widely used operation that has radically improved the quality of life of millions of people during the last few decades. However, some technical details, concerning the surgical procedure and the rehabilitation following total knee arthroplasty, are still a matter of a strong debate. In this review of the literature, we have included the best evidence available of the last decade, in an effort to shed light on some of the most controversial subjects related to TKR surgery. Posterior-stabilized or cruciate-retaining prosthesis? To use a tourniquet during operation or not? Do patients need continuous passive motion for their post-surgery rehabilitation? To resurface patella or not? These are some of the most controversial topics that until now have been persistent dilemmas for the orthopedic surgeon. Results of this systematic review of the literature are highly controversial. These conflicting results are an indication that larger and more well conducted high quality trials are needed in order to gain more secure answers. At the same time, it is becoming apparent that a meticulous operative technique, respecting the soft tissue envelope and knowing the principles of alignment and soft tissue balancing, are some of the parameters that might contribute more to achieving the optimal results for the patients. Key words: Total knee replacement; Controversy; Literature review; Patella resurfacing; Patella eversion; Posterior stabilized; Cruciate retaining; Tourniquet; Continuous passive motion Core tip: A literature review has been conducted in an effort to present the best available evidence of the last decade and to shed light on some of the most controversial subjects related to total knee replacement surgery. Patella resurfacing or not? Posterior cruciate retaining or sacrificing? Continuous passive motion or not? Tourniquet or not? These are some of the most debatable topics that until now have been persistent dilemmas for the orthopedic surgeon. Results of this systematic review of the literature are highly controversial. These conflicting results are an indication that larger and better conducted high quality trials are needed in order to gain more secure answers.Nikolaou VS, Chytas D, Babis GC. Common controversies in total knee replacement surgery: Current evidence. World J Orthop 2014; 5(4

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Section: Is It Necessary To Use a Tourniquet?mentioning

confidence: 99%

“…No advantage to using a tourniquet in knee replacement surgery for reduction of transfusion requirements Rama et al [17] Meta-analysis of randomized trials. Tourniquet release either before or after wound closure…”

Section: Tourniquet Use or Notmentioning

confidence: 99%

Common controversies in total knee replacement surgery: Current evidence

Nikolaou¹

2014

WJO

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“…Major bleeding and blood transfusions after TKA occur in 3% to 5% [18] and 21% to 53% of patients [11,15,19], respectively. Various surgical techniques [9,11,16,17,19], medications [5,15,22], and postoperative protocols [2,4,8,12] to reduce bleeding have been proposed.…”

Section: Introductionmentioning

confidence: 99%

“…Various surgical techniques [9,11,16,17,19], medications [5,15,22], and postoperative protocols [2,4,8,12] to reduce bleeding have been proposed. Various postoperative approaches including cold compresses [6], elastic bandage support [7], and compressive dressings [1] also have been reported for reduction of bleeding, soft tissue edema, and hemarthroses.…”

Section: Introductionmentioning

confidence: 99%

Can A Modified Robert Jones Bandage After Knee Arthroplasty Reduce Blood Loss? A Prospective Randomized Controlled Trial

Pinsornsak¹,

Chumchuen²

2013

Clinical Orthopaedics &Amp; Related Research

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“…этому спо-собствуют очевидные преимущества, которые он позволяет получить: уменьшение продолжитель-ности оперативного вмешательства, снижение объема интраоперационной кровопотери, отлич-ная визуализация во время оперативного вмеша-тельства, обеспечение оптимальных условий для цементной фиксации имплантата [7][8][9].…”

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Efficiency and Safety of Tourniquet During Total Knee Arthroplasty: When to Perform Release?

Чугаев¹,

Корнилов²,

Kogan³

2017

Traumatology and Orthopedics of Russia

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Use of a pneumatic tourniquet during total knee arthroplasty is an effective option allowing reduction of the time of surgery and intraoperative blood loss. At the same time, there are a lot of researchers who advocate differing tactical approaches to the duration of the tourniquet application — the so-called “early” and “late” releases.Purpose of the study. To assess the effectiveness and safety of various methods of tourniquet use during primary total knee arthroplasty.Material and methods. 72 patients with end-stage knee osteoarthritis were randomly divided into two equal prospective groups: 1) keeping the tourniquet throughout the surgery, including wound closure (late release); 2) performing knee arthroplasty using the tourniquet until after implantation of the prosthesis component and implementation of hemostasis after the release of the tourniquet (early release). Such aspects as perioperative blood loss and changes in blood counts, blood transfusion volume, and severity of pain on the VAS scale, the rate of recovery of the knee joint function and number of postoperative complications were assessed during hospital stay of patients.Results. The duration of procedures was 70±15,4 min for the Group I with tourniquet throughout surgery (late release) and 95±27,5 for the Group II with early release (p = 0,001). On the 7th day after the arthroplasty the authors observed statistically significant differences (p0,05) in the dynamics of reducing the level of hemoglobin, red blood cells and hematocrit in patients of compared groups — in patients who underwent late release of the tourniquet, these indicators were higher. When assessing the rate of recovery of knee joint function according to the KSS -and the intensity of the pain syndrome no significant statistical differences were found in the patients of both groups.Conclusion. Application of the tourniquet throughout the surgery to release after closure of the surgical wound does not lead to a sharp increase in the number of ischemic and thromboembolic complications, while at the same time, the application of this methodology to a large extent maintains hemoglobin indicators, red blood cells and hematocrit at a high level without a critical decrease.

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Timing of Tourniquet Release in Knee Arthroplasty

Abstract: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

Cited by 79 publications

References 48 publications

Common controversies in total knee replacement surgery: Current evidence

Common controversies in total knee replacement surgery: Current evidence

Can A Modified Robert Jones Bandage After Knee Arthroplasty Reduce Blood Loss? A Prospective Randomized Controlled Trial

Efficiency and Safety of Tourniquet During Total Knee Arthroplasty: When to Perform Release?

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