Effects of Tourniquet Pressure on Rehabilitation Outcomes in Patients Undergoing Total Knee Arthroplasty

Ünver, Bayram; Karatosun, Vasfi; Tuncalı, Bahattin

doi:10.1097/nor.0b013e31829aef2a

Cited by 21 publications

(23 citation statements)

References 20 publications

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“…Others have observed pain is greater with higher tourniquet inflation pressure [59,63]. Although our examination of pain was purely descriptive (we were underpowered for a thorough statistical examination of group differences in all outcomes), the group means we observed suggest against a clinically meaningful effect of tourniquet use on postoperative pain levels.…”

Section: Discussionmentioning

confidence: 78%

Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

Dennis

Kittelson

Yang

et al. 2016

Clinical Orthopaedics &Amp; Related Research

160

148

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Background Tourniquet use during total knee arthroplasty (TKA) improves visibility and reduces intraoperative blood loss. However, tourniquet use may also have a negative impact on early recovery of muscle strength and lower extremity function after TKA. Questions/purposes The purpose of this study was (1) to determine whether tourniquet use affects recovery of quadriceps strength (primary outcome) during the first 3 postoperative months; and (2) to examine the effects of tourniquet application on secondary outcomes: voluntary quadriceps activation, hamstring strength, unilateral limb balance as well as the effect on operative time and blood loss.Methods Twenty-eight patients (mean age 62 ± 6 years; 16 men) undergoing same-day bilateral TKA (56 lower extremities) were enrolled in a prospective, randomized study. Subjects were randomized to receive a tourniquetassisted knee arthroplasty on one lower extremity while the contralateral limb underwent knee arthroplasty without extended tourniquet use. In the former group, the tourniquet was inflated just before the incision was made and released after cementation; in the latter group, a tourniquet was not used (10 of 28 [36%]) or inflated only during component cementation (18 of 28 [64%]). The choice of no tourniquet or use just during cementation was based on surgeon choice, because some surgeons felt a tourniquet during cementation was necessary to achieve a dry surgical field to maximize cement fixation. A median parapatellar approach and the One or more of the authors (DAD, CCY, TMM, RHK) has received funding from Porter Adventist Hospital, during the study period, in the amount of USD 10,000 to USD 100,000. One of the authors (DAD) has or may receive payments or benefits from DePuy (Warsaw, IN, USA) in the amount of USD more than USD 1,000,001 not related to this work. One of the authors certifies that he (RHK) has or may receive payments or benefits from Stryker (Kalamazoo, MI, USA) and Innomed (Savannah, GA, USA) in the amount of USD 100,001 to USD 1,000,001 not related to this work. One of the authors (TMM) has or may receive payments or benefits from Zimmer (Warsaw, IN, USA) in the amount of less than USD 10,000 not related to this work. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.The surgeries for this study were performed at Porter Adventist Hospital, Denver, CO, USA, and the postoperative patient te...

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Section: Discussionmentioning

confidence: 78%

Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

Dennis

Kittelson

Yang

et al. 2016

Clinical Orthopaedics &Amp; Related Research

160

148

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“…However, a higher inflation pressure has a higher risk of complications, such as sustained thigh pain, neurologic deficit, compartment syndrome, and even systemic complications, such as hypertension and DVT [1, 2, 4, 13–15]. Recent systematic reviews recommended to apply tourniquet for <2 h and deflate it for short intervals of 10–15 min to minimize the risks of complications related to tourniquet application [16, 17].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of a new elastic tourniquet cuff in total knee arthroplasty: a prospective randomized controlled study

Lee

2017

BioMed Eng OnLine

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BackgroundThe effects of cuff shape, timing of tourniquet application, and automated systems using limb occlusion pressure (LOP) have been reported to minimize the appropriate tourniquet pressure. However, studies on the raw material of the cuff itself to reduce the complications related to the tourniquet have been very rarely reported. The purpose of this study is to report the efficacy and safety of a tourniquet system with a new elastic cuff in which pressure is set with LOP in total knee arthroplasty (TKA).MethodsA total of 63 patients who underwent primary TKA for osteoarthritis were enrolled from July to December 2015. Thirty-one patients were allocated to the new elastic cuff group and 32 in the conventional cuff group. Bloodless surgical field, pain visual analog scale (VAS) on the thigh, thigh circumference, range of motion, incidence of deep vein thrombosis, and muscle enzyme level after surgery were checked and compared between the 2 groups.ResultsOnly 1 of the 31 patients in the elastic cuff group required more pressure for obtaining a bloodless surgical field, whereas 4 of the 32 patients in the conventional cuff group required more pressure to complete surgery without being disturbed by sustained bleeding. Two patients in the conventional cuff group needed treatment for blisters and bullae at the tourniquet application site. There was no difference in pain VAS score, thigh circumference, range of motion, incidence of deep vein thrombosis, and level of muscle enzyme.ConclusionsA new elastic tourniquet cuff provided a more proper bloodless surgical field with less adjustment of tourniquet pressure despite a similar level of tourniquet pressure compared to the conventional cuff and had a low incidence of skin complications on the site of tourniquet application in TKA. These benefits make it an effective and safe medical device for orthopedic surgery requiring a tourniquet, such as TKA.

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“…In our previous studies, we used a CHAMIP technique which provided a bloodless field in all patients with a mean tourniquet pressure of 169.7±7.9 mmHg and 118.2±7.2 mmHg which were significantly lower inflation pressures than reported and recommended in the literature in lower and upper extremity surgeries respectively. [13,14,19] Nwachukwu et al [20] also found that obesity is an independent risk factor for poor hemodynamic control during TKA. In our study, the mean initial systolic blood pressures and the mean intraoperative maximal systolic blood pressures were found to be more elevated in obese group.…”

Section: Discussionmentioning

confidence: 96%

“…Therefore, we used the controlled hypotension and minimal inflation pressure (CHAMIP) technique, which provided a bloodless field in all patients, with a mean tourniquet pressure of 169.7±7.9 mmHg for lower extremity surgeries and 118.2±7.2 mmHg for upper extremity surgeries in our previous studies, values significantly lower than those previously reported and recommended in the literature. [13,14] In all patients, the thigh circumference was measured 20 cm proximal to the superior pole of the patella with the knee extended by a tape measure and recorded. The tourniquet cuff was placed around the thigh with the distal edge 15 cm proximal to proximal…”

Section: Methodsmentioning

confidence: 99%

Obese patients require higher, but not high pneumatic tourniquet inflation pressures using a novel technique during total knee arthroplasty

Tuncalı

Boya

Kayhan

et al. 2018

Eklem Hastalik Cerrahisi

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Effects of Tourniquet Pressure on Rehabilitation Outcomes in Patients Undergoing Total Knee Arthroplasty

Abstract: We conclude that TKA operations with a tourniquet application at lower inflation pressures might minimize the complications of tourniquet use and the patients can gain more rapidly early functional mobility.

Cited by 21 publications

References 20 publications

Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

Efficacy and safety of a new elastic tourniquet cuff in total knee arthroplasty: a prospective randomized controlled study

Obese patients require higher, but not high pneumatic tourniquet inflation pressures using a novel technique during total knee arthroplasty

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