Effect of Tourniquet Use on Activation of Coagulation in Total Knee Replacement

Aglietti, Paolo; Baldini, Andrea; Vena, L. M.; Abbate, Rosanna; Fedi, Stefano; Falciani, M.

doi:10.1097/00003086-200002000-00021

Cited by 173 publications

(131 citation statements)

References 21 publications

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“…Harvey et al [7] found the incidence of DVT was unrelated to tourniquet use, whereas others observed an increased incidence [14]. Recently, a hypercoagulative status, which seems to be higher when a tourniquet is not used, has been reported [1]. The low incidence of DVT in our study may be due to prophylaxis with enoxaparine, where we followed the international consensus statement regarding prevention of venous thromboembolism [8,16].…”

Section: Discussionmentioning

confidence: 55%

The effect of tourniquet use in total knee arthroplasty

Vandenbussche

Duranthon

Couturier

et al. 2002

International Orthopaedics

157

152

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We conducted a prospective, randomised study on primary total knee replacements to evaluate the effects of tourniquet use on total calculated blood loss using Gross formula, post-operative measured blood loss, operating time, need for blood transfusion, post-operative pain, analgesia requirement and knee flexion. Forty patients were operated on with the use of an arterial tourniquet with pressure of 350 mmHg (group A), and 40 patients without the use of a tourniquet (group B). Total calculated blood loss was significantly increased (P=0.0165) without the use of a tourniquet. There was no significant difference in measured blood loss or operating time. The median units of blood given were similar in both groups. In spite of autologous transfusions 14% of patients received additional homologous transfusions. At 6 h post-operatively pain was significantly less (P=0.0458) in group B but was similar at 24 and 48 h. There was no significant difference in analgesia requirement. The mean change in total flexion in group B was significantly better (P<0.001) at 5 days than in group A, but knee flexion was similar at 10 days and 3 months. Knee arthroplasty operations without the use of a tourniquet cause a greater blood loss but have only small benefits in the early post-operative period.Résumé Une étude prospective et randomisée a été réali-sée sur 80 arthroplasties totales du genou consécutives de première intention dans le but d'évaluer l'effet de l'utilisation du garrot pneumatique sur les pertes sanguines totales calculées selon la formule de Gross, les pertes sanguines mesurées par drainage aspiratif, la durée opératoire, la né-cessité de transfusion sanguine, la douleur post-opératoire, le besoin d'antalgique et la récupération de la flexion du genou. Quarante patients ont été opérés avec un garrot pneumatique gonflé à 350 mmg (group A), et quarante sans garrot pneumatique (group B). Les pertes sanguines totales calculées étaient plus élevées de façon significative (P=0.0165) dans le groupe B. Il n'y avait pas de différence significative entre les deux groupes sur les pertes sanguines mesurées par drainage aspiratif et la durée opératoire. Le nombre de culots globulaires nécessaire était le même dans les deux groupes. Malgré un protocole d'autotransfusion, 14% des patients ont eu une transfusion homologue complémentaire. La douleur post-opératoire était significativement moindre (P=0.0458) à la sixième heure dans le groupe B mais était identique à 24 et 48 heures. Il n'y avait pas de différence sur la consommation d'antalgique. La flexion dans le groupe B était meilleure (P<0.001) au cinquième jour que dans le groupe A, mais était identique à 10 jours et au troisième mois post-opératoire pour les deux groupes. La non-utilisation d'un garrot pneumatique apporte quelques bénéfices dans la période post-opératoire immédiate mais est responsable d'une majoration des pertes sanguines totales calculées. IntroductionDespite progress in pre-operative autologous donation, intraoperative normovolaemic haemodilution and...

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Section: Discussionmentioning

confidence: 55%

The effect of tourniquet use in total knee arthroplasty

Vandenbussche

Duranthon

Couturier

et al. 2002

International Orthopaedics

157

152

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“…In a recent clinical study, Reikerås et al found significant local thrombogenic and fibrinolytic activity in the operative leg after tourniquet deflation but no significant systemic impact [18]. Moreover, it was previously suggested that a hypercoagulative state is more likely to appear in TKA cases in which no tourniquet is used [1]. In this study we did not specifically screen for clinically relevant clotting events, but it remains doubtful that we would have been able to detect any such outcomes with such a limited preconditioning routine.…”

Section: Discussionmentioning

confidence: 98%

Does Limb Preconditioning Reduce Pain After Total Knee Arthroplasty? A Randomized, Double-blind Study

Memtsoudis

Stundner

Yoo

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Total knee arthroplasty (TKA) can be associated with considerable postoperative pain. Ischemic preconditioning of tissue before inducing procedure-related underperfusion may reduce the postoperative inflammatory response, which further may reduce associated pain. Questions/purposes In this prospective, randomized study, we aimed at evaluating the impact of ischemic preconditioning on postoperative pain at rest and during exercise; use of pain medication; levels of systemic prothrombotic and local inflammatory markers; and length of stay and achievement of physical therapy milestones. Methods Sixty patients undergoing unilateral TKA under tourniquet were enrolled with half (N = 30) being randomized to an episode of limb preconditioning before induction of ischemia for surgery (tourniquet inflation). Pain scores, analgesic consumption, markers of inflammation (interleukin-6 [IL-6], tumor necrosis factor [TNF]-a in periarticular drainage), and periarticular circumference were measured at baseline and during 2 days postoperatively. Changes in prothrombotic markers were evaluated. Results Patients in the preconditioning group had significantly less pain postoperatively at rest (mean difference = À0.71, 95% confidence interval [CI] = À1.40 to À0.02, p = 0.043) and with exercise (mean difference = À1.38, 95% CI = À2.32 to À0.44, p = 0.004), but showed no differences in analgesic consumption. No differences were seen between the study and the control group in terms of muscle oxygenation and intraarticular levels of IL-6 and TNF-a as well as levels of prothrombotic markers. No differences were found between groups in regard to hospitalization length and time to various physical therapy milestones. Conclusions Ischemic preconditioning reduces postoperative pain after TKA, but the treatment effect size we observed with the preconditioning routine used was modest.

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“…Fibrinolysis is stimulated by surgical trauma [29,44] and further augmented by the use of a tourniquet [2,14,31,32,36,40]. This increased fibrinolytic activity may increase blood loss after TKA, at least during the early postoperative hours.…”

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confidence: 99%

Tranexamic Acid Reduces Blood Loss and Blood Transfusion after TKA: A Prospective Randomized Controlled Trial

Charoencholvanich

Siriwattanasakul

2011

Clinical Orthopaedics &Amp; Related Research

138

105

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Background TKA may be associated with considerable blood loss, and transfusion carries substantial risk of immunologic reaction and disease transmission. Blood transfusion also involves additional cost, therefore a reduction in its use is important. Several methods reportedly reduce postoperative blood loss and avoid homologous blood transfusion with traditional TKA approaches, but it is unclear these reductions apply to a minimally invasive technique. Questions/purposes We asked whether tranexamic acid administration could reduce blood loss and blood transfusion requirements after TKA.

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Effect of Tourniquet Use on Activation of Coagulation in Total Knee Replacement

Cited by 173 publications

References 21 publications

The effect of tourniquet use in total knee arthroplasty

The effect of tourniquet use in total knee arthroplasty

Does Limb Preconditioning Reduce Pain After Total Knee Arthroplasty? A Randomized, Double-blind Study

Tranexamic Acid Reduces Blood Loss and Blood Transfusion after TKA: A Prospective Randomized Controlled Trial

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