Effect of Tourniquet Use on Patient Outcomes After Cementless Total Knee Arthroplasty: A Randomized Controlled Trial

Smith, Austin; Usmani, Rashad H.; Wilson, Khaleel D.; Smith, Langan S.; Malkani, Arthur L.

doi:10.1016/j.arth.2021.01.053

Cited by 12 publications

(6 citation statements)

References 15 publications

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“…However, the aforementioned study population included rTKAs for both aseptic and septic causes. Although the present study included only aseptic rTKA cases, our findings are consistent with the results of several studies showing no difference in LOS with or without tourniquet use in primary TKA including that by Smith et al [27] and the meta-analysis of 14 RCTs performed by Deering et al [28]. Some previous reports have proposed that LOS may potentially be longer for patients who had a tourniquet inflated due to quadriceps pain leading to decreased strength and poor physical therapy progress in these patients [10e12].…”

Section: Discussionsupporting

confidence: 92%

Tourniquet Use Is Associated With Reduced Blood Loss and Fewer Reoperations in Aseptic Revision Total Knee Arthroplasty

Singh

Robin

Fiedler

et al. 2022

The Journal of Arthroplasty

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Section: Discussionsupporting

confidence: 92%

Tourniquet Use Is Associated With Reduced Blood Loss and Fewer Reoperations in Aseptic Revision Total Knee Arthroplasty

Singh

Robin

Fiedler

et al. 2022

The Journal of Arthroplasty

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“…Herein, experts agreed that serum myoglobin and serum creatine kinase could be used as markers of muscle damage after surgery, which is consistent with previous studies [ 40 ] that have used it extensively to assess the extent of muscle damage after TKA [ 41 , 42 ]. It has been reported that muscle damage and healing after MRI and ultrasound can identify TKA, but MRI was eliminated from the first round of expert consultation because of its high cost and poor convenience.…”

Section: Discussionsupporting

confidence: 86%

Indicators and medical tests to identify lower limb swelling causes after total knee arthroplasty: a Delphi study with multidisciplinary experts

Yang,

Wu,

Wang

et al. 2023

J Orthop Surg Res

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Background Lower limb swelling after total knee arthroplasty (TKA) hinders surgical effectiveness. The poor results of studies on swelling interventions are due to the lack of a classification of swelling causes through appropriate medical tests. A gold standard is missing. This study aimed to clarify the causes of TKA postoperative swelling and how to identify them through indicators and medical tests by consulting a wide range of experts from multiple disciplines. Method The Delphi method was used. A first draft of the index was prepared based on a systematic search of the literature. A total of 11 experts from several disciplines were invited to evaluate the rationality of the indicators and suggest modifications. After two rounds of consultation, the experts reached a consensus, and the consultation was stopped. Results The response rate of the 11 experts was 100%, and the authoritative Cr was 0.896. Kendall's W values for opinion coordination of the two rounds of consultation were 0.262 and 0.226, respectively (P < 0.001). Among the final indicators, there were 4 primary indicators for swelling cause classification (inflammatory response, poor venous return, joint hematoma, muscle damage, and healing), 19 secondary and 19 tertiary indicators. Conclusion The indications obtained by systematic literature review and multidisciplinary expert consultation are reliable and scientific. Multiple causes of lower extremity swelling after TKA were identified. Blood test indicators can reflect an inflammatory response, suggest poor venous return, and reflect muscle damage and healing progress. Ultrasound scans are needed to identify underlying thrombotic or valvular problems, joint hematomas, and muscle damage. These tests help clinicians and researchers determine the cause of swelling after TKA and take appropriate management.

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“…Zak et al 26 found that tourniquet use did not affect pain scores, opioid consumption, or length of stay. Similar findings were also reported by Smith et al 27 , who concluded that there were no substantial benefits with the use of short tourniquet time (instead of long tourniquet time) in primary TKA with regard to opioid consumption, patient-reported pain, KSS, length of stay, and postoperative hemoglobin levels.…”

Section: Bleeding Control and Thromboprophylaxissupporting

confidence: 88%

What’s New in Adult Reconstructive Knee Surgery

Villa

Singh

Higuera-Rueda

2022

Journal of Bone and Joint Surgery

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Over the past year, areas of investigation in total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) such as bleeding control, thromboprophylaxis, pain management, technology-assisted surgery, and infection received major attention. We have included selected studies, many at the highest Levels of Evidence, in an attempt to summarize the most relevant recent findings. Economics of Added TechnologyAhmed et al. 1 evaluated the adoption of computer-assisted knee arthroplasty between the first quarter of 2010 and the third quarter of 2017 in the states of New York and Florida, making use of 2 statewide administrative databases (the Statewide Planning and Research Cooperative System in New York and the Florida Administrative Data in Florida). The proportion of computerassisted knee arthroplasty increased from 4.89% to 9.45% in New York, and from 4.03% to 5.73% in Florida. In New York, that represented a 93.3% growth in utilization. One of the reasons preventing the widespread adoption of these new technologies is their increased costs. In a Markov model, Rajan et al. 2 ascertained the cost-effectiveness of robotic-assisted TKA compared with conventional TKA. Robotic-assisted TKA produced 13.55 qualityadjusted life-years (QALYs) compared with 13.29 QALYs for conventional TKA. Because of its higher QALYs, robotic-assisted TKA remains cost-effective despite being associated with higher costs as long as annualized revision rates stay <1.6%. The costutility of patient-specific instrumentation for TKA compared with the standard of care among patients with a body mass index (BMI) of >30 kg/m 2 was evaluated; patient-specific instrumentation was more costly and less effective 3 . A secondary analysis of a randomized clinical trial (RCT) comparing closed-incision, negative-pressure therapy with the standard of care after revision TKA revealed that the total per-patient costs for surgical-site management were $1,047 for closed-incision, negative-pressure therapy and $2,036 for the standard of care 4 . Knee OsteoarthritisGenetic markers seem to play a role in advanced knee osteoarthritis. Utilizing clinical and genomic data, investigators showed that age and BMI contributed more to the risk of developing end-stage disease than genetic factors. However, 7 genetic loci were significantly associated with end-stage osteoarthritis. The effects of genetic factors were greater in patients who were <60 years of age 5 . The use of hyaluronic acid and platelet-rich plasma remains controversial. Among Medicare patients, hyaluronic acid utilization increased from 1,090,503 patients in 2012 to 1,209,489 patients in 2018 (p = 0.04), and total costs related to hyaluronic acid services increased from $290.10 million to $325.02 million (p < 0.01) 6 . In patients with hemophilic knee arthritis, a trial compared the effects of platelet-rich plasma injections with those of placebo on outcomes over a 24-month follow-up. There were no clinically important differences in the Western Ontario and McMaster Universities Osteoarthritis I...

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Effect of Tourniquet Use on Patient Outcomes After Cementless Total Knee Arthroplasty: A Randomized Controlled Trial

Cited by 12 publications

References 15 publications

Tourniquet Use Is Associated With Reduced Blood Loss and Fewer Reoperations in Aseptic Revision Total Knee Arthroplasty

Tourniquet Use Is Associated With Reduced Blood Loss and Fewer Reoperations in Aseptic Revision Total Knee Arthroplasty

Indicators and medical tests to identify lower limb swelling causes after total knee arthroplasty: a Delphi study with multidisciplinary experts

What’s New in Adult Reconstructive Knee Surgery

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