Defining tourniquetless total knee arthroplasty: A systematic review

Constantinescu, David S.; Pavlis, William; Sudah, Suleiman Y.; Berge, Dennis Vanden; Geller, Joseph S.; Hernández, Victor H.

doi:10.1016/j.jor.2022.09.003

Cited by 2 publications

(1 citation statement)

References 21 publications

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“…Another strategy selected by many surgeons is to inflate the tourniquet during the cementation process of prosthesis, with the aim of decreasing the tourniquet time (54,55). In the 54), the efficacy and safety of different tourniquet protocols in TKA were compared, showing that a tourniquet during the entire operation process can effectively reduce blood loss but also may cause many safety problems, including DVTs, wound oozing, delayed healing, and serious wound complications, while tourniquet inflation before osteotomy and then deflation after wound closure can effectively shorten the operation time, reduce perioperative bleeding, and reduce postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Tourniquet application in primary total knee arthroplasty for osteoarthritis: A systematic review and meta-analysis of randomized controlled trials

Jinchang

Zhang

et al. 2023

Front. Surg.

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ObjectiveThe aim of this study was to identify the influence of a tourniquet on the blood loss, transfusion requirement, swelling, pain, knee function, range of motion (ROM), operation time, bone cement mantle thickness, and complications in patients operated with total knee arthroplasty (TKA).MethodsTwo authors independently retrieved PubMed, Embase, and CENTRAL to identify eligible randomized controlled trials (RCTs) evaluating the effectiveness of a tourniquet in TKA. Fixed- (I2 < 50%) or random-effects (I2 > 50%) models were selected to perform meta-analysis according to the value of I2. Mean difference (MD) and risk ratio were selected as the effect sizes for continuous and dichotomous variables, respectively.ResultsA total of 29 RCTs, involving 2,512 operations (1,258 procedures with a tourniquet and 1,254 procedures without a tourniquet), were included, and 18 outcomes were compared. Tourniquet application could significantly decrease intraoperative blood loss (MD = −138.72 ml, p < 0.001), shorten operation duration (MD = −1.77 min, p < 0.001), and increase cement mantle thickness (MD = 0.17 mm, p < 0.001). However, it was significantly associated with increased postoperative pain intensity, decreased full ROM/flexion ROM/extension ROM, poorer knee function, increased knee swelling, and increased length of hospital stay (LOS) at several follow-up points (p < 0.050). No significant difference was found for postoperative draining volume, total blood loss, transfusion rate, change of Hb level, and risks of deep venous thrombosis and all complications.ConclusionsTourniquet application could only decrease the intraoperative blood loss but has no effectiveness on the total blood loss and transfusion requirement. On the contrary, it has a reverse effect on the pain score, knee function, ROM, swelling, and LOS.

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Section: Discussionmentioning

confidence: 99%

Tourniquet application in primary total knee arthroplasty for osteoarthritis: A systematic review and meta-analysis of randomized controlled trials

Jinchang

Zhang

et al. 2023

Front. Surg.

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Tranexamic Acid and Tourniquet: Which Combination Reduces Blood Loss Most Effectively?

Bayrak,

Adiguzel,

Demir

et al. 2024

Nigerian Journal of Clinical Practice

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Background: Blood loss during and after total knee arthroplasty (TKA) can lead to substantial morbidity and the need for blood transfusions. There are several methods to minimize blood loss and decrease transfusion rates in patients undergoing TKA. Tranexamic acid, an antifibrinolytic agent with known efficacy for achieving these goals, is combined with tourniquets to reduce bleeding in arthroplasty surgeries. Our study investigated the effects of various combinations of tranexamic acid and tourniquet use on bleeding in knee arthroplasty in 558 patients. Aim: We aimed to determine the method that would provide the least blood loss and transfusion need in knee arthroplasty surgery. Methods: Between January 2018 and December 2022, 558 patients aged between 55 and 85 years underwent TKA surgery for grade 4 gonarthrosis in our clinic, and their decrease in hemoglobin value and whether they were transfused or not were analyzed. The patients were divided into four groups based on use of tranexamic acid and tourniquet. Demographic variables and patient data (body mass index, INR values, and preoperative hemoglobin values) were recorded. Results: There were 558 patients with a mean age of 68.19 (67 ± 6.949) years. In group 1, tranexamic acid was not used in 128 patients and tourniquet was used only during cementation; in group 2, in 132 patients, tranexamic acid was not used and tourniquet was used throughout the surgery; in group 3, in 158 patients, tranexamic acid was used and tourniquet was used throughout the surgery; in group 4, in 140 patients, tranexamic acid was used and tourniquet was used only during cementation. The decrease in hemoglobin value and transfusion rate was lowest in group 3 and highest in group 1. Besides, there was a greater decrease in hemoglobin value in group 2 than in group 4 and the transfusion rate was similar. Conclusions: This clinical study showed that using tranexamic acid and a tourniquet throughout surgery significantly reduced the decrease in hemoglobin value and the need for transfusion.

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Defining tourniquetless total knee arthroplasty: A systematic review

Cited by 2 publications

References 21 publications

Tourniquet application in primary total knee arthroplasty for osteoarthritis: A systematic review and meta-analysis of randomized controlled trials

Tourniquet application in primary total knee arthroplasty for osteoarthritis: A systematic review and meta-analysis of randomized controlled trials

Tranexamic Acid and Tourniquet: Which Combination Reduces Blood Loss Most Effectively?

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