Association of tourniquet utilization with blood loss, rehabilitation, and complications in Chinese obese patients undergoing total knee arthroplasty

Li, Zhirui; Liu, Daohong; Long, Gong; Gong, Kan; An, Xingwei; Tang, Peifu; Dong, Jun

doi:10.1097/md.0000000000009030

Cited by 16 publications

(12 citation statements)

References 12 publications

(16 reference statements)

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“…[11][12][13][14][15][16] A similar finding was also observed in obese patients, where tourniquet use was not associated with reduced blood loss or increased postoperative complications following TKA. [17] Nevertheless, many reports had demonstrated reduced intraoperative blood loss and total blood loss when tourniquets were used, [18][19][20][21] whereas others found increased total blood loss resulting from hemolysis if a tourniquet was used. [22] This difference in the reported studies could be attributed to many factors, including pre-operative hemoglobin levels, surgical techniques, patient's gender, patient's age, or ethnic group.…”

Section: Introductionmentioning

confidence: 99%

Effect of tourniquet use on total blood loss following total knee arthroplasty

Alzahrani

Alqarni

Taybe

et al. 2021

JMSR

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Objectives: Blood loss during total knee arthroplasty (TKA) can be a concern. Therefore, a tourniquet (TQ) is commonly used during the procedure to minimize this risk. However, the use of a TQ in TKA continues to be a matter of debate among orthopedic surgeons and is related to its advantages and disadvantages. We retrospectively evaluated the impact of applying the TQ on total blood loss following TKA in 276 patients. Methods: Patients were categorized into two groups: TQ and non- TQ. Demographics, surgical time, pre- and post-operative hemoglobin levels, number of blood units transfused, and rate of venous thromboembolism (VTE) were compared between the groups. The mean age of the study population was 62.8 ± 7.2 years, and 76.4% of patients were females. The TQ group consisted of 159 patients, whereas the non-TQ group consisted of 117 patients. Results: The two groups were homogenous, and there was no statistically significant difference in age or gender distribution between the two groups. The results showed no significant difference in total blood loss, need for blood transfusion, or VTE rate postoperatively when using a TQ. Female gender was identified to be a significant predictor of a decrease in post-operative hemoglobin. Conclusion: We found that the use of the TQ had no effect on total blood loss following primary TKA. Female gender was a predictor of increased blood loss in both groups. It is essential that surgeons performing arthroplasty balance the risks and benefits of using a TQ during TKA.

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Section: Introductionmentioning

confidence: 99%

Effect of tourniquet use on total blood loss following total knee arthroplasty

Alzahrani

Alqarni

Taybe

et al. 2021

JMSR

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“…To contrast, other scholars hold an opposite idea. Their studies nd that tourniquet have no signi cant impact on postoperative outcomes in TKA patients [4,11,12] . Considering the bloodless surgical eld and shorter operation time, they propose regular application of tourniquet in TKA.…”

Section: Introductionmentioning

confidence: 98%

The Effect of Tourniquet Application on the Morphology and Function of Quadriceps in Patients Undergoing Total Knee Arthroplasty: A Study Protocol for a Single Blind Randomized Controlled Trial

Dong

Tao

et al. 2021

Preprint

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Background:Tourniquet is currently widely used in total knee arthroplasty to reduce intraoperative blood loss. Academic view of tourniquet application in TKA is now in dispute. Some scholars argue that tourniquet may cause quadriceps injury and bring extra side effects so they oppose the application of tourniquet. Others find that tourniquet application has no significant adverse impact on TKA patients. Regarding its advantages in reducing intraoperative blood loss, they advocate regular application of tourniquet in TKA. Quadriceps injury is considered the main cause of tourniquet side effects. There are now many high-quality trials about tourniquet application in TKA but few of them concentrate on quadriceps morphology and function.Methods:A prospective, single blind, randomized controlled trail will be adopted. The target sample is 130. Patients who meet the eligibility criteria will be randomly allocated to tourniquet group and non-tourniquet group. Primary outcomes are thickness, stiffness and function of quadriceps, which will be evaluated by ultrasound and rehabilitation tests. Secondary outcomes consist of circumference of thigh, VAS score, opioid consumption, knee function score, postoperative satisfaction score, operation time, intraoperative blood loss, perioperative blood loss, blood transfusion rate, D-Dimer, C-reactive protein, and complications. Discussion:This proposed study will contribute to improve evidence of tourniquet application in total knee arthroplasty. This will be a high-quality single blind randomized controlled trial with sufficient sample size and strict study design. It will investigate the effects of tourniquet application especially on the morphology and function of quadriceps in patients undergoing total knee arthroplasty and offer advice for tourniquet application in clinical practice.Trial registration:Chinese clinical trial registry, ChiCTR2000035097. Registered 31 July 2020, http://www.chictr.org.cn/showproj.aspx?proj=57093

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“…Currently, many studies [ 16 – 19 ] have confirmed that TXA can significantly reduce intraoperative and postoperative bleeding during HTO without increasing the risk of complications. In addition, several studies have reported that forgoing routine use of tourniquets in total knee arthroplasty (TKA) using modern TXA protocols does not increase total blood loss, but facilitates rapid recovery [ 20 , 21 ]. However, there is a paucity of data that explores the effect of tourniquet use in HTO with modern TXA protocols.…”

Section: Introductionmentioning

confidence: 99%

Impact of tourniquet on short-term outcomes in opening wedge high tibial osteotomy with modern tranexamic acid protocols: a retrospective cohort study

Wang

Zhang

Wang

et al. 2021

BMC Musculoskelet Disord

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Background The use of a tourniquet during high tibial osteotomy (HTO) is a routine procedure, but there is currently no research on the benefits and potential risks of tourniquet use during HTO. The aim of this study was to investigate the impact of tourniquet on perioperative blood loss, early functional recovery and complications in opening wedge HTO with modern tranexamic acid protocols. Methods This was a retrospective cohort study of patients who underwent unilateral opening wedge HTO between January 2019 and September 2020. All patients were divided into two groups according to whether a tourniquet was applied during HTO. Patients in both groups received the same surgical procedures, tranexamic acid protocols and other perioperative treatments. Preoperative baseline data, intraoperative data, early postoperative recovery and all complications during the 3-month follow-up were collected and compared between the two groups. Results A total of 62 patients were enrolled in this study, including 32 in the tourniquet group and 30 in the non-tourniquet group. There was no significant difference in preoperative baseline data between the two groups (P > 0.05 in all). Intraoperative blood loss in the tourniquet group was significantly lower than that in the non-tourniquet group (80.22 ml versus 94.00 ml, P < 0.001), but there was no difference in total blood loss (187.39 ml versus 193.31 ml, P = 0.714). And no patient in either group required blood transfusion. In terms of early postoperative recovery, tourniquet use significantly increased pain scores and reduced knee range of motion on the first and second postoperative days, but there was no significant difference between the two groups at postoperative third day and third month. Furthermore, there was no significant difference between the two groups in terms of lower limb force line correction, length of stay, Knee Society Score or the incidence of complications during the 3-month follow-up (P > 0.05 in all). Conclusions In opening wedge HTO with modern tranexamic acid protocols, not using a tourniquet does not increase perioperative total blood loss or the risk of complications, but facilitates early postoperative recovery by reducing pain and increasing range of motion.

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Association of tourniquet utilization with blood loss, rehabilitation, and complications in Chinese obese patients undergoing total knee arthroplasty

Cited by 16 publications

References 12 publications

Effect of tourniquet use on total blood loss following total knee arthroplasty

Effect of tourniquet use on total blood loss following total knee arthroplasty

The Effect of Tourniquet Application on the Morphology and Function of Quadriceps in Patients Undergoing Total Knee Arthroplasty: A Study Protocol for a Single Blind Randomized Controlled Trial

Impact of tourniquet on short-term outcomes in opening wedge high tibial osteotomy with modern tranexamic acid protocols: a retrospective cohort study

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