Tourniquet Use Improves Cement Penetration and Reduces Radiolucent Line Progression at 5 Years After Total Knee Arthroplasty

Hegde, Vishal; Bracey, Daniel N.; Johnson, Roseann M.; Dennis, Douglas A.

doi:10.1016/j.arth.2020.12.048

Cited by 23 publications

(19 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Radiographic assessments have also proven to be useful in our study, because patients with complications may be asymptomatic [ 33 ]. Meanwhile, postoperative radiographs by measuring the periprosthetic radiolucent line are the more established method of assessing implant stability [ 34 ]. On the other hand, our study also had certain limitations, such as the fact that it was retrospective and no comparison group was involved.…”

Section: Discussionmentioning

confidence: 99%

Staged replacement of both hips and both knees in patients with rheumatoid arthritis

Cao

Wang

Feng

et al. 2023

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background Patients with rheumatoid arthritis (RA) undergoing bilateral total hip arthroplasty (THA) and total knee arthroplasty (TKA) are an uncommon population, and their outcomes are also difficult to predict. The purpose of this study was to evaluate whether both bilateral cementless THA and cemented posterior-stabilized TKA (PS-TKA) can provide reliable outcomes for RA patients. Methods We retrospectively reviewed 30 RA patients (60 hips and 60 knees) who underwent both elective bilateral cementless THA and cemented PS-TKA, with a minimum follow-up of 2 years. Clinical, patient-reported, and radiographic data were retrospectively analyzed. Results The mean follow-up was 84 months (range, 24–156). By the last follow-up, the post-operative range of motion, Harris Hip Score, Knee Society Score (KSS) clinical, KSS functional, Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) hip, and WOMAC knee scores were significantly improved compared to the preoperative values. All patients achieved the ability to walk. In addition, overall satisfaction scores on a 100-point scale were 92.5 after THA and 89.6 after TKA. Only one patient underwent revision surgery due to knee joint instability, and all replaced hips and knees were radiographically stable by the assessment of the radiolucent line. The proportion of implants that did not suffer loosening or require revision surgery was 99.2% during the 84-month follow-up, based on Kaplan-Meier analysis. Conclusions Our study suggests that bilateral cementless THA and cemented PS-TKA provides reliable mid-long-term clinical, patient-reported, and radiographic outcomes in RA patients, with high survivorship and patient satisfaction.

show abstract

Section: Discussionmentioning

confidence: 99%

Staged replacement of both hips and both knees in patients with rheumatoid arthritis

Cao

Wang

Feng

et al. 2023

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…Our results are consistent with that literature. Reducing IBL in TKA has been reported to improve cement penetration and initial fixation strength, reducing the long-term risk of aseptic loosening [ 3 ]. Whether tourniquets affect this is unclear, and we could not address this question because of the relatively short follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Total knee arthroplasty (TKA) is considered the most effective therapy for patients with end-stage knee arthritis because it can relieve pain and improve joint function [ 1 ]. However, TKA is usually accompanied by massive intraoperative bleeding and a poor surgical field of view, which may prolong surgery and inhibit cement penetration [ 2 , 3 ]. Longer surgery increases the risk of surgical site infection, re-operation, and blood transfusion [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Tourniquets can further reduce perioperative blood loss in patients on dexamethasone and tranexamic acid during cemented total knee arthritis: a single-center, double-blind, randomized controlled trial

Jiang

Wang

et al. 2023

J Orthop Traumatol

View full text Add to dashboard Cite

Background Multiple doses of dexamethasone and tranexamic acid can inhibit postoperative inflammation and reduce fibrinolysis and perioperative blood loss in total knee arthroplasty. In this single-center, double-blind, randomized clinical trial, the aim was to investigate whether applying a tourniquet to patients on dexamethasone and tranexamic acid could further reduce perioperative blood loss. Materials and methods Patients who underwent cemented total knee arthroplasty at our hospital were randomized to receive a tourniquet (n = 71) or not (n = 70) during the procedure. All patients received multiple doses of dexamethasone and tranexamic acid perioperatively. The primary outcome was perioperative blood loss, while secondary outcomes were surgery duration, postoperative laboratory indices of inflammation and fibrinolysis, range of knee motion, VAS pain score, knee circumference, knee swelling rate, homologous transfusion, albumin use, and complications. Results Using a tourniquet was associated with significantly lower intraoperative blood loss (P < 0.001) and total blood loss (P = 0.007) as well as significantly shorter surgery duration (P < 0.001). In contrast, the tourniquet did not significantly affect hidden blood loss, postoperative inflammation or fibrinolysis, range of knee motion, VAS pain score, knee circumference, knee swelling rate, homologous transfusion, albumin use, or complications. Conclusions The results of this randomized clinical trial demonstrate that applying a tourniquet during cemented total knee arthroplasty to patients receiving multiple doses of dexamethasone and tranexamic acid can further reduce perioperative blood loss without increasing the risk of inflammation, fibrinolysis, or other complications. Thus, it is advised to use tourniquets combined with dexamethasone and tranexamic acid to reduce perioperative blood loss and avoid tourniquet-related adverse events. Level of evidence: Therapeutic Level I. Trial registration Chinese Clinical Trail Registry, ChiCTR2200060567. Registered 5 June 2022—retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=171291.

show abstract

“…Consensus dictates that cement should be applied to clean and dry bone, and extensive literature has been devoted to achieving that goal; the use of pulsed lavage, intraosseous suction, and compressed carbon dioxide have been described [14]. In addition, other intraoperative factors such as the use of a tourniquet may also play a role in cement penetration [35,36].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Working Time and Application Technique on Cement Penetration into a Tibial Model

Schmicker

Goel

Davis³

et al. 2022

Arthroplasty Today

View full text Add to dashboard Cite

Tourniquet Use Improves Cement Penetration and Reduces Radiolucent Line Progression at 5 Years After Total Knee Arthroplasty

Cited by 23 publications

References 28 publications

Staged replacement of both hips and both knees in patients with rheumatoid arthritis

Staged replacement of both hips and both knees in patients with rheumatoid arthritis

Tourniquets can further reduce perioperative blood loss in patients on dexamethasone and tranexamic acid during cemented total knee arthritis: a single-center, double-blind, randomized controlled trial

The Effect of Working Time and Application Technique on Cement Penetration into a Tibial Model

Contact Info

Product

Resources

About