Blood level changes in total knee arthroplasty with and without a tourniquet

Abstract

ObjectiveTo evaluate the difference between the total blood loss in patients undergoing primary total knee arthroplasty with and without the use of tourniquet.MethodsA retrospective cohort study, with analysis of medical records of patients undergoing primary total knee arthroplasty in 2015, with and without the use of a tourniquet. Comparison was performed of hemoglobin (HB) and hematocrit (HT) variation in the complete blood count (CBC) during the pre- and post-operative period between the two groups.ResultsThere were 117 patients undergoing primary total knee arthroplasty included, minimum age of 33 and maximum of 86 years, with a mean of 67 years. 64.1% of the surgeries used a tourniquet and 35.9% did not. The mean preoperative HB in Group 1 was 13.08 and 12.97 in Group 2 (p = 0.435). The mean postoperative HB in Group 1 was 11.64 and 10.93 in Group 2 (p = 0.016). The variation of HB in Group 1 was 1.44 and 2.04 in Group 2 (p = 0.025). The mean preoperative HT in Group 1 was 38.96 and 39.01 in Group 2 (p = 0.898). The mean postoperative HT in Group 1 was 34.47 and 32.19 in Group 2 (p = 0.005). The variation of HT in Group 1 was 4.49 and 6.82 in Group 2 (p = 0.001). A total of 21 patients received transfusions RCC (red cell concentrates), as a result of HB below 8 g/dL or clinical symptoms, respectively, representing seven of Group 1 (9.3% of total intra-group) and 14 of Group 2 (33.3% of total intra-group), with p = 0.001.ConclusionIn patients undergoing primary total knee arthroplasty using a tourniquet, a lower variance in the hematimetric indices was observed and fewer blood transfusions were necessary.

Tourniquet and tranexamic acid use in total knee arthroplasty

“…This finding is consistent with prior literature demonstrating the effectiveness of tourniquet use in reducing intraoperative blood loss [18,19,51]. The true relationship between tourniquet use and transfusion rates in TKA has been a topic of much debate with numerous conflicting results [18,20,[52][53][54]. Our study showed no significant difference in transfusion rates between TA and TU groups, consistent with the findings of Wang et al [54] and Zhang et al [16].…”

Tourniquet use in routine primary total knee arthroplasty is associated with a higher transfusion rate and longer postoperative length of stay: a real-world study

“…Although several studies have evaluated the influence of tourniquet use during TKA on blood loss and transfusion, no consensus has been reached about whether or not to use a tourniquet in routine primary TKA because of the diversity of current literature results [ 17 ]. A retrospective cohort study of 117 patients by Barros et al [ 18 ] showed that tourniquet use in TKA resulted in a lower decrease in hemoglobin and hematocrit as well as fewer necessary blood transfusions. Surprisingly, Schnettler et al [ 19 ] reported that tourniquet application during TKA resulted in a paradoxical increase in blood loss.…”

The effect of limited versus no tourniquet use on rapid recovery in total knee replacement--a randomized controlled trial

“…Therefore, there was a signi cant negative correlation between the length of tourniquet use and postoperative complications. The latest opinion on whether to use tourniquet in total knee arthroplasty: By comparing the postoperative rehabilitation of patients in the group with and without tourniquet, it has been found that the non-use of tourniquet in total knee arthroplasty can reduce the postoperative pain and limb swelling, without increasing the risk of postoperative complications, and without affecting the quality of prosthesis installation and xation [21,22]. It has been suggested that long-term use of tourniquet can reduce intraoperative and intraoperative total blood loss, while short-term use of tourniquet can reduce postoperative and postoperative hidden blood loss without increasing the rate of allogeneic blood transfusion [23].…”