Tourniquet use in primary total knee arthroplasty is associated with a hypercoagulable status: a prospective thromboelastography trial

Huang, Chao-ran; Pan, Sheng; Zheng, Lirong; Ruan, Ru-xin; Jin, Wang-Yi; Zhang, Xingchen; Pang, Yong; Guo, Kaijin; Zheng, Xin

doi:10.1007/s00264-021-05126-x

Cited by 8 publications

(6 citation statements)

References 39 publications

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“…Most asymptomatic DVTs after TKA are estimated to occur within the first 4 postoperative days [22]. Therefore, postoperative day 7 was considered to be the appropriate time to perform Doppler ultrasound [7]. However, asymptomatic DVTs after TKA do not all occur within the first 7 postoperative days [18], so further prospective studies that reveal the natural history of asymptomatic DVT after RATKA after postoperative day 7 are needed.…”

Section: Discussionmentioning

confidence: 99%

“…There have been reports of continued improvement in operation times when using RATKA [1, 11], and further shortening of the time taken to perform RATKA could further reduce the incidence of DVT. Third, the routine use of a tourniquet can increase the risk of DVT [7]. However, given the conflicting results in the literature regarding DVT [19], the use of tourniquets during TKA is controversial.…”

Section: Discussionmentioning

confidence: 99%

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Robotic‐assisted total knee arthroplasty is not associated with increased risk of postoperative deep vein thrombosis

et al. 2023

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Purpose Prolongation of operation time due to registration and pin insertion has been reported with robotic-assisted total knee arthroplasty (RATKA), and there has been concern about an increase in the postoperative incidence of deep vein thrombosis (DVT). In this study, we compared the incidence of DVT after RATKA with that after conventional manual TKA (mTKA). Methods This consecutive retrospective series included 141 knees that underwent primary TKA using the Journey II system. The CORI robot was used. There were 60 RATKAs and 81 mTKAs. Doppler ultrasound was performed in all patients on postoperative day 7 to determine whether DVT was present. Results The operation time was longer in the RATKA cohort (99.5 min vs 78.0 min, p < 0.001). The overall incidence of DTV was 43.9% (62/141 knees), all of which were asymptomatic. There was no significant difference in incidence of DVT between RATKA and mTKA (50.0% vs 39.5%, p = 0.23). Use of the robot did not affect the incidence of DVT following TKA (odds ratio 1.02, 95% confidence interval 0.40–2.60; p = 0.96). Conclusion The incidence of DVT was not significantly different between RA-TKA and mTKA. Multiple logistic regression indicated that RATKA is not associated with increased risk of postoperative DVT. Level of evidence IV.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Robotic‐assisted total knee arthroplasty is not associated with increased risk of postoperative deep vein thrombosis

et al. 2023

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“…When the surgery is completed, complete release of the tourniquet can cause local blood pressure to recover, leading to joint cavity bleeding and increased drainage volume. Second, long-term use of a tourniquet may cause venous stasis and produce a hypercoagulable state[ 15 ] and small thrombi, leading to increased red blood cell consumption. Third, long-term use of a tourniquet also leads to limb ischemia-reperfusion injury,[ 16 ] local hypoxia, aggravated inflammatory reaction, increased red blood cell injury, vascular endothelial injury, and increased interstitial bleeding.…”

Section: Discussionmentioning

confidence: 99%

Controlled hypotension technology can improve patient recovery in the early postoperative period after total knee arthroplasty: A prospective, randomized controlled clinical study

Li,

Liu,

Wang

et al. 2023

Jt Dis Relat Surg

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Objectives The study aimed to analyze the application of controlled hypotension and tourniquets in total knee arthroplasty (TKA) to evaluate their early postoperative period effects in TKA. Patients and methods A total of 183 patients (43 males, 140 females; mean age: 67.8±6.4 years; range, 50 to 84 years) with knee osteoarthritis who needed TKA were recruited for this prospective, randomized controlled clinical study between August 2022 and May 2023. The study included a tourniquet group (group T, 94 patients) and a controlled hypotension group (group H, 89 patients). In group T, an inflatable tourniquet was used throughout the operation, with the pressure of the tourniquet set at 300 mmHg. In group H, controlled hypotension was used, with the mean arterial pressure controlled at 55-65 mmHg. The outcome measures of this study included blood loss, coagulation function, inflammatory mediators, knee joint function, permeation thickness of bone cement around the tibial prosthesis, and cognitive function. Results The baseline demographics and clinical characteristics of the two groups of patients were comparable (p>0.05). Intraoperative blood loss in group H was higher than that in group T (p<0.05), whereas hemoglobin decrease, postoperative drainage flow, hidden blood loss, and total blood loss in group T were higher than in group H (p<0.05). Fibrinogen, D-dimer, C-reactive protein, and interleukin-6 levels were higher in group T than in group H on the first and third postoperative days (p<0.05). The knee joint function of group H was significantly better than that of group T on the fifth day and one month after the operation (p<0.05). There was no significant difference in the penetration thickness of bone cement around the tibial prosthesis between the two groups (p>0.05). There was no significant difference in Mini-Mental State Examination scores between the two groups on the same day (p>0.05). Conclusion Controlled hypotension technology in TKA can reduce total blood loss by reducing hidden blood loss and can help to alleviate the postoperative hypercoagulable state, relieve inflammatory reactions, and facilitate early recovery of knee joint function after surgery.

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“…The TEG was more sensitive than CCT. 19 Compared with CCT, TEG can analyze the kinetics of clot formation from the initial fibrin threads to fibrinolysis. 20 , 21 Unlike plasma-based tests, TEG can provide a comprehensive analysis of a patient’s coagulation status.…”

Section: Introductionmentioning

confidence: 99%

The effect of triple-dose-intravenous tranexamic acid on blood loss in patients undergoing total hip arthroplasty without affecting blood coagulopathy: A prospective thromboelastographic analysis

Jin,

Yan,

Zhang

et al. 2024

Acta Orthopaedica et Traumatologica Turcica

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Objective: This study aimed to assess the safety and efficacy of triple-dose intravenous tranexamic acid (TXA) in patients following total hip arthroplasty (THA) using thromboelastography (TEG). Methods: One hundred thirty patients undergoing THA were prospectively enrolled in the study. According to the intravenous infusion TXA dose, patients were divided into single-dose (n = 65; mean age = 60.8 ± 8.1 years) and triple-dose groups (n = 65; mean age = 61.8 ± 8.6 years). Complete blood count (CBC), conventional coagulation tests (CCT), and TEG were conducted 1 day before the operation, on postoperative day 1 (POD1), and postoperative day 7 (POD7). Color Doppler ultrasonography was performed 1 day before the operation and on POD7. Drainage blood loss, total blood loss (TBL), hidden blood loss (HBL), deep vein thrombosis (DVT) incidence, and blood transfusion rates were calculated and recorded. The CCT, CBC, and TEG parameters were compared between the 2 groups. Results: Single- and triple-dose groups had significantly different hematocrit on POD7 ( P < .05). No significant differences were found in CCT and hemoglobin at any corresponding time point between the 2 groups ( P > .05). Despite the reaction time (R) on POD1 ( P < .05), there were no significant differences in other TEG parameters at any other time point between the 2 groups ( P > 0.05). For drainage blood loss and TBL, the triple-dose group had lesser blood loss than the single-dose group ( P < .05). However, no significant differences were found for blood transfusion rate, HBL, or incidence of DVT ( P > .05). Conclusion: Compared with single-dose, triple-dose TXA can be more effective in decreasing blood loss without increasing DVT incidence in patients undergoing THA. Although there is a notable disparity in the R time on POD1, the administration of triple-dose TXA does not substantially impact the coagulation status as assessed by TEG and CCT. Level of Evidence: Level I, Therapeutic study.

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Tourniquet use in primary total knee arthroplasty is associated with a hypercoagulable status: a prospective thromboelastography trial

Cited by 8 publications

References 39 publications

Robotic‐assisted total knee arthroplasty is not associated with increased risk of postoperative deep vein thrombosis

Robotic‐assisted total knee arthroplasty is not associated with increased risk of postoperative deep vein thrombosis

Controlled hypotension technology can improve patient recovery in the early postoperative period after total knee arthroplasty: A prospective, randomized controlled clinical study

The effect of triple-dose-intravenous tranexamic acid on blood loss in patients undergoing total hip arthroplasty without affecting blood coagulopathy: A prospective thromboelastographic analysis

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