Timing of Tourniquet Release in Total Knee Arthroplasty When Using a Postoperative Blood Salvage Drain

Steffin, Brian; Green-Riviere, Emilia; Giori, Nicholas J.

doi:10.1016/j.arth.2008.01.302

Cited by 25 publications

(27 citation statements)

References 12 publications

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“…Six studies [14–16,21,22,25] compared postoperative blood loss. The pooled result demonstrated no significant difference between the 2 groups (WMD = −45.41, 95% CI: −120.11 to 29.29, P = .233, I 2 = 1%) (Fig.…”

Section: Resultsmentioning

confidence: 99%

Timing of tourniquet release in total knee arthroplasty

Zhang

Liang

et al. 2017

Medicine

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Background:For total knee arthroplasty (TKA), the tourniquet is routinely employed for better visualization, less blood loss, and easier cementation. However, the time to release tourniquet remains controversial. Therefore, we performed current meta-analysis to assess whether releasing tourniquet before wound closure is more effective in reducing blood loss than releasing tourniquet after wound closure in TKA without an increased risk of complications.Methods:To conduct this meta-analysis, we searched Medline, Embase, Web of science, and the Cochrane library up to November 2016, for randomized controlled trials comparing tourniquet releasing before and after wound closure in TKA. A meta-analysis was performed following the guidelines of the Cochrane Reviewer's Handbook and the PRISMA statement. Methodological quality of the trials was assessed using the Cochrane risk assessment scale. The data of the included studies were analyzed using Stata 12.0.Results:Sixteen trials involving 1010 patients were identified in current meta-analysis. Our meta-analysis demonstrated that there were no significant differences in the 2 groups in terms of calculated blood loss (weighted mean difference [WMD] = 160.65, 95% confidence interval [CI]: −0.2 to 321.49, P = .05), postoperative blood loss (WMD = −45.41, 95% CI: −120.11 to 29.29, P = .233),postoperative hemoglobin decline (WMD = 0.16, 95% CI: −2.5 to 2.82, P = .905), transfusion volume (WMD = 79.19, 95% CI: −5.05 to 163.44, P = .065),transfusion rates (relative risk [RR] = 1.19, 95% CI: 0.95–1.50, P = .134), major complications (RR = 0.51, 95% CI: 0.15–1.73, P = .278), and deep vein thrombosis (RR = 0.44, 95% CI: 0.14–1.37, P = .157).Compared with the group of releasing tourniquet after wound closure, the group of releasing tourniquet before wound closure had a higher volume of total blood loss (WMD = 130.96, 95% CI: 58.83–203.09, P = .000) and a longer operation time (WMD = 6.56, 95% CI: 3.12–10.01, P = .000). However, releasing tourniquet before wound closure could reduce minor complications (RR = 0.53, 95% CI: 0.34–0.82, P = .004).Conclusions:On the basis of current meta-analysis, the method of releasing tourniquet before wound closure could increase total blood loss and operation time; nevertheless, the risk of complications decreased. Thus, if patients are in severe anemia condition, the tourniquet perhaps should be released after wound closure to decrease blood loss. In contrary, releasing tourniquet before wound closure to decrease the risk of complications would be a better choice.

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Section: Resultsmentioning

confidence: 99%

Timing of tourniquet release in total knee arthroplasty

Zhang

Liang

et al. 2017

Medicine

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“…So, some authors have thought that the release of the tourniquet after skin closure might be effective. Therefore, there are many studies in literature which have been conducted to investigate the effect of tourniquet release time, with reports of different results regarding blood loss and complications (Table 3) [4,9,14,16,[21][22][23]]. In the current study, tourniquet release after skin closure decreased postoperative blood loss significantly.…”

Section: Discussionmentioning

confidence: 80%

“…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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“…This has in recent times revolutionized the associated blood loss with such procedures (5,6). Consideration should also be given to varying operative techniques such as early tourniquet release followed by intraoperative achievement of hemostasis, which aim to decrease the associated complications (7). The authors also failed to describe the method of intra-operative blood loss measurement.…”

Section: Accepted Manuscriptmentioning

confidence: 97%