The influence of tourniquet use and operative time on the incidence of deep vein thrombosis in total knee arthroplasty

Hernandez, Arnaldo José; Almeida, Arací Malagodi de; Fávaro, Edmar; Sguizzato, Guilherme Turola

doi:10.6061/clinics/2012(09)12

Cited by 47 publications

(34 citation statements)

References 45 publications

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“…There was a decrease in leg circumference from post-operative day 2 to day 7, but with no statistical significance. [21]. In the present study, 27.5% of TKA patients developed DVT post-operatively, with both the tibial and fibular veins compromised in 54% of the cases.…”

Section: Discussionsupporting

confidence: 45%

Clinical, Laboratory and Echografic Evaluation of Patients with Deep Vein Thrombosis Following Total Knee Arthroplasty

Schwartsmann¹,

Binz²,

Ferreira³

et al. 2019

OJO

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Introduction: Total knee arthroplasty, being a major surgery, carries a risk of post-operative deep vein thrombosis (DVT). The main objective of the present study was to elucidate the association of clinical, laboratory, and echographic findings with the occurrence of DVT. Patients and Methods: The present study was prospective and non-randomized, with restricted exclusion criteria. Forty patients were submitted to total knee arthroplasty due to osteoarthritis. Patients were clinically evaluated by laboratory tests, assessment of pain and calf circumference, and the presence of Homans' sign. Echo Doppler was performed in each patient on postoperative day 7. The echographic evaluation divided the patients into two groups: positive (G1) and negative for thrombosis (G2). All patients received prophylactic heparin during the 7-day hospital admission. Results: Eleven patients complained of pain (analgesic medication was used during the entire admission). Leg circumference variation from the pre-operative period to post-operative day 7 was: G1, 1.70 ± 1.12 cm and G2, 0.68 ± 1.25 cm (p = 0.03). Homans' sign was considered positive in 10 patients. Echographic evaluation was positive in 11 patients (27.5%). No cases of pulmonary embolism, infection, or death were observed. Conclusions: The incidence of DVT was 27.5%, with an increase in leg circumference being the main predictive factor (p = 0.03).

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Section: Discussionsupporting

confidence: 45%

Clinical, Laboratory and Echografic Evaluation of Patients with Deep Vein Thrombosis Following Total Knee Arthroplasty

Schwartsmann¹,

Binz²,

Ferreira³

et al. 2019

OJO

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“…Furthermore, there are also studies claiming that the incidence of DVT after TKA is considerably high with or without the application of a tourniquet [30,32,33]. What is more, the research by Hernandez et al proved that surgery time rather than tourniquet time was the main cause leading to DVT and that surgery lasting longer than 120 minutes increased the risk of DVT in TKA [34]. Anyhow, anticoagulant therapy and early ultrasound examination will make sense in prevention of post-operative DVT and pulmonary thromboembolism in TKA [35][36][37][38].…”

Section: Discussionmentioning

confidence: 99%

The influence of a half-course tourniquet strategy on peri-operative blood loss and early functional recovery in primary total knee arthroplasty

Chen

Peng

et al. 2013

International Orthopaedics (SICOT)

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“…The cuff produces a distal bloodless field improving visualization which allows the surgeon to work with greater technical precision (2). It also facilitates cement setting and decrease blood loss and operating time (3,4). A bloodless field time of 120 min has been considered to be safe (5) and a lower cuff pressure is probably beneficial to the patient (6,7).…”

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confidence: 99%

Tourniquet versus no tourniquet on knee-extension strength early after fast-track total knee arthroplasty; a randomized controlled trial

Harsten¹,

Bandholm²,

Kehlet³

et al. 2015

The Knee

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Tourniquet versus no tourniquet on knee-extension strength early after fast-track total knee arthroplasty; a randomized controlled trial.Harsten, Andreas; Bandholm, Thomas; Kehlet, Henrik; Toksvig-Larsen, Sören Link to publication Citation for published version (APA): Harsten, A., Bandholm, T., Kehlet, H., & Toksvig-Larsen, S. (2015). Tourniquet versus no tourniquet on kneeextension strength early after fast-track total knee arthroplasty; a randomized controlled trial. Knee, 22(2), 126-130. DOI: 10.1016/j.knee.2014 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal TKA= total knee arthroplasty, CNS= central nervous system, ASA = American Society of Anesthesiologists, PACU= post anaesthesia care unit, LOS = length of hospital stay Declaration of interestNone declared FundingThe study was supported with institutional grants.Trial registry number: NCT01808859. The study was approved by the Research Ethics Committee at Lund University (no 2012/11) and was carried out at Hässleholm Hospital, Sweden.TKA= total knee arthroplasty, CNS= central nervous system, ASA = American Society of Anesthesiologists, PACU= post anaesthesia care unit, LOS = length of hospital stay AbstractBackground. Thigh tourniquet is commonly used in total knee arthroplasty (TKA) but may contribute to pain and muscle damage. Consequently, the reduction in knee-extension strength after TKA may be caused by quadriceps muscle ischaemia underneath the cuff.Aim. To examine if not using a thigh tourniquet during surgery was more effective than using a thigh tourniquet in preserving knee-extension strength 48hours after fast-track TKA. Methods.A total of 64 patients undergoing TKA were randomized (1:1) to the use of tourniquet (T-group) or no tourniquet (NT-group). In the T-group the tourniquet cuff pressure was based on the patient's systolic pressure and a margin of 100 mm Hg. It was inflated immediately before surgery and deflated as soon as surgery ended. The primary outcome was the change in kneeextension strength from pre-surgery to 48 hours after surgery (primary end point). Secondary outcomes were pain, nausea, length of hospital stay (LOS) and periarticular swelling.Results. Knee-extension strength 48 hours after surgery was substantially reduced by about 90% in both groups, with no statistically significant difference between groups (mean difference 1.5 N/kg, 95% CI 1.3-1.6). Among the secondary outcomes, the T-group had less bleeding during surgery (56 vs 182 mL, P < 0.01) compared with the NT-g...

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The influence of tourniquet use and operative time on the incidence of deep vein thrombosis in total knee arthroplasty

Cited by 47 publications

References 45 publications

Clinical, Laboratory and Echografic Evaluation of Patients with Deep Vein Thrombosis Following Total Knee Arthroplasty

Clinical, Laboratory and Echografic Evaluation of Patients with Deep Vein Thrombosis Following Total Knee Arthroplasty

The influence of a half-course tourniquet strategy on peri-operative blood loss and early functional recovery in primary total knee arthroplasty

Tourniquet versus no tourniquet on knee-extension strength early after fast-track total knee arthroplasty; a randomized controlled trial

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