Tourniquet time affects postoperative complications after knee arthroplasty

Olivecrona, Charlotta; Lapidus, Lasse J; Benson, Lina; Blomfeldt, Richard

doi:10.1007/s00264-013-1826-4

Cited by 88 publications

(70 citation statements)

References 22 publications

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“…Operative time did not differ between limbs assigned to the tourniquet procedure (62 ± 11 minutes) and limbs assigned to the notourniquet procedure (65 ± 10 minutes). As expected, the average tourniquet time in the tourniquet group was greater than the no-tourniquet group (group difference = 42 minutes [95% CI, [37][38][39][40][41][42][43][44][45][46][47]; p \ 0.001).…”

Section: Resultssupporting

confidence: 63%

“…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]. Additionally, some have reported an increased incidence of deep venous thrombosis [8,57,65], arterial thrombosis in subjects with preoperative vascular disease [26,48,49], and peripheral nerve injury [28,39].…”

Section: Discussionmentioning

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

170

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: Resultssupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

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

170

148

View full text Add to dashboard Cite

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“…In addition, its use for more than an hour during TKA increases the risk for local arterial and venous thrombosis [15]. Meanwhile, the introduction of modern cementing techniques and the use of tranexamic acid may obviate the need for a tourniquet during TKA [16].…”

Section: Introductionmentioning

confidence: 99%

Tranexamic Acid Reduces Blood Loss and Transfusion in Patients Undergoing Total Knee Arthroplasty without Tourniquet: A Prospective Randomized Controlled Trial

Bidolegui¹,

Arce²,

Lugones³

et al. 2014

TOORTHJ

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Introduction : Blood loss during and after total knee arthroplasty (TKA) can lead to substantial morbidity and the need for blood transfusions. There are several methods to minimize blood loss and to decrease transfusion rates in patients undergoing TKA. Tranexamic acid is an antifibrinolytic agent with known efficacy for achieving these goals. Currently, many surgeons are performing TKA without the use of tourniquet. Consequently, the aim of the study is to evaluate whether tranexamic acid reduces blood loss during and after TKA without the adjunctive use of above-the-knee tourniquet.Methods : We performed a prospective randomized controlled trial (1:1 fashion) on the use of tranexamic acid versus placebo in 50 patients undergoing TKA (without tourniquet). The treatment group received two (preoperative and postoperative) 15 mg/kg doses. The primary endpoint was blood transfusion rate. We collected data about demographic and procedural characteristics, hemoglobin and hematocrit values, drain blood loss at 24 hours as well as adverse events.Results : There were no transfusions in the treatment group, whereas 32% of the control group required transfusion (p<0.01). The treatment group had higher hematocrit and hemoglobin levels at 24, 48 and 72 hours after surgery (all p<0.01) and lower drain loss at 24hours (363.4±141 vs 626±260ml, p=<0,001). There were no in-hospital or six-month thromboembolic complications.Discussion : A double-dose of tranexamic acid was safe and effective, reducing blood loss and preventing the need of blood transfusion in patients undergoing TKA without above-the-need tourniquet.

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“…It has been recommended that TT be limited to 2 h in human studies due to the increase in postoperative complications caused by an extended TT [10]. Investigating the relationship between TT and postoperative complications in arthroplastic knee surgery, Olivecrona et al [17] found an increase in postoperative complications including wound leakage, local injury due to TP, nerve damage, compartment syndrome, deep venous thrombosis, and pulmonary embolism with every 10-min increment in TT.…”

Section: Discussionmentioning

confidence: 99%

Does Tourniquet Time or Pressure Contribute to Intracranial Pressure Increase following Tourniquet Application?

Beşir

Tuğcugil

2018

Med Princ Pract

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Objective: The aim of this study was to determine whether an early increase in intracranial pressure (ICP) following the deflation of a tourniquet is related to the tourniquet time (TT) or tourniquet pressure (TP) and to identify a safe cut-off value for TT or TP. Materials and Methods: Patients who underwent elective orthopedic lower-extremity surgery under general anesthesia were randomized into 2 groups: group A (inflation with a pneumatic TP of systolic blood pressure + 100 mm Hg; n = 30) and group B (inflation using the arterial occlusion pressure formula; n = 30). The initial and maximum TPs, TT, and sonographic measurements of optic-nerve sheath diameter (ONSD) and end-tidal CO₂ values were taken at specific time points (15 min before the induction of anesthesia, just before, and 5, 10, and 15 min after the tourniquet was deflated). Results: The initial and maximum TPs were found to be significantly higher in group A than in group B. At 5 min after the tourniquet deflation, there was a significant positive correlation between TT and ONSD (r = 0.57, p = 0.0001). When ONSD ≥5 mm was taken as a standard criterion, the safe cut-off value for the optimal TT was found to be < 67.5 min (sensitivity 87% and specificity 59.5%). Conclusion: The ICP increase in the early period after tourniquet deflation was well correlated with TT but not with TP. TT of ≥67.5 min was found to be the cut-off value and is considered the starting point of the increase in ICP after tourniquet deflation.

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Tourniquet time affects postoperative complications after knee arthroplasty

Abstract: Tourniquet time over 100 minutes increases the risk of complications after knee arthroplasty surgery and special attention is advocated to reduce the tourniquet time.

Cited by 88 publications

References 22 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

Tranexamic Acid Reduces Blood Loss and Transfusion in Patients Undergoing Total Knee Arthroplasty without Tourniquet: A Prospective Randomized Controlled Trial

Does Tourniquet Time or Pressure Contribute to Intracranial Pressure Increase following Tourniquet Application?

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