Effects of Unilateral Tourniquet Used in Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty

Liu, Peilai; Li, Deqiang; Yuankai, Zhang; Lu, Qiong; Ma, Liang; Bao, Xue‐zhi; Zhang, Meng

doi:10.1111/os.12329

Cited by 28 publications

(34 citation statements)

References 25 publications

(28 reference statements)

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“…It is known that short-duration tourniquet use would result in faster recovery and less pain during the early rehabilitation period following TKA. 16 –18 In the present trial, the short-duration tourniquet group was associated with better clinical outcomes, less pain, and reduced limb swelling during the early stage of rehabilitation (Figure 4). Similar results were reported by Zhang et al 19 and Ejaz et al 20 A possible explanation is that longer tourniquet use results in more pronounced oxidative stress, inflammatory response, and tissue necrosis.…”

Section: Discussionmentioning

confidence: 57%

Effects of tourniquet application on enhanced recovery after surgery (ERAS) and ischemia-reperfusion post-total knee arthroplasty: Full- versus second half-course application

Cao

Fan

et al. 2020

J Orthop Surg (Hong Kong)

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Purpose: Pneumatic tourniquets are used in total knee arthroplasty (TKA) for surgical field visualization and improved cementation; however, their use is controversial. This study aimed to assess the effects of tourniquet application on enhanced recovery post-TKA. Methods: A prospective randomized single-blinded trial assessed tourniquet’s effects on postoperative pain, swelling, and early outcome in TKA. One-hundred and two patients with knee osteoarthritis were randomized to full-course (FC) and second half-course (SHC) application ( n = 51/group). Tumor necrosis factor-alpha (TNF-α), C-C motif chemokine ligand 2(CCL-2), pentraxin-3 (PTX-3), prostaglandin E-2 (PGE-2), superoxide dismutase-1 (SOD-1), and myoglobin (Mb) were assessed by enzyme-linked immunosorbent assay, while the visual analog scale (VAS), range of motion (ROM), and thigh circumference growth rate were recorded. Results: Average tourniquet duration significantly differed between the SHC (37.5 ± 5.1 min) and FC (66.4 ± 7.2 min) groups ( p < 0.01); VAS and thigh circumference growth rate in the SHC group were much lower compared with the FC group, while ROM was higher within 48 h of tourniquet removal ( p < 0.01). Blood TNF-α, PTX3, CCL2, PGE2, SOD-1, and Mb were lower in the SHC group than the FC group ( p < 0.01). Additionally, intraoperative blood loss was significantly elevated in the SHC group than the FC group ( p < 0.01), with lower postoperative blood loss in the drain ( p = 0.001). Postoperative drainage volume was reduced in the SHC group compared with the FC group ( p < 0.01); five and two patients in the FC and SHC groups required blood transfusion, respectively ( p = 0.025). Hospital stay tended to be shorter in the SHC group ( p = 0.023), and no tourniquet-related complications were recorded. Conclusion: Improved therapeutic outcome was observed in the SHC group, indicating patients should routinely undergo TKA with SHC tourniquet application.

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Section: Discussionmentioning

confidence: 57%

Effects of tourniquet application on enhanced recovery after surgery (ERAS) and ischemia-reperfusion post-total knee arthroplasty: Full- versus second half-course application

Cao

Fan

et al. 2020

J Orthop Surg (Hong Kong)

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“…Four studies (n = 425) reported three-month scores. 16 , 21 , 38 , 54 The standardized mean difference between the two groups was 0.64 lower in the tourniquet group (95% CI -1.52 to 0.52) compared to the group without a tourniquet. Five studies (n = 611) participants reported 12 month scores.…”

Section: Resultsmentioning

confidence: 85%

Time to reconsider the routine use of tourniquets in total knee arthroplasty surgery

Ahmed

Chawla

Underwood

et al. 2021

The Bone & Joint Journal

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Aims Many surgeons choose to perform total knee arthroplasty (TKA) surgery with the aid of a tourniquet. A tourniquet is a device that fits around the leg and restricts blood flow to the limb. There is a need to understand whether tourniquets are safe, and if they benefit, or harm, patients. The aim of this study was to determine the benefits and harms of tourniquet use in TKA surgery. Methods We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled trials, and trial registries up to 26 March 2020. We included randomized controlled trials (RCTs), comparing TKA with a tourniquet versus without a tourniquet. Outcomes included: pain, function, serious adverse events (SAEs), blood loss, implant stability, duration of surgery, and length of hospital stay. Results We included 41 RCTs with 2,819 participants. SAEs were significantly more common in the tourniquet group (53/901 vs 26/898, tourniquet vs no tourniquet respectively) (risk ratio 1.73 (95% confidence interval (CI) 1.10 to 2.73). The mean pain score on the first postoperative day was 1.25 points higher (95% CI 0.32 to 2.19) in the tourniquet group. Overall blood loss did not differ between groups (mean difference 8.61 ml; 95% CI -83.76 to 100.97). The mean length of hospital stay was 0.34 days longer in the group that had surgery with a tourniquet (95% CI 0.03 to 0.64) and the mean duration of surgery was 3.7 minutes shorter (95% CI -5.53 to -1.87). Conclusion TKA with a tourniquet is associated with an increased risk of SAEs, pain, and a marginally longer hospital stay. The only finding in favour of tourniquet use was a shorter time in theatre. The results make it difficult to justify the routine use of a tourniquet in TKA surgery.

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“…Da die Studien verschiedene Einnahmezeitpunkte oder Arten der Morphinapplikation beschrieben, konnte keine Analyse durchgeführt werden. Zwei andere Studien (n = 178) untersuchten die Kniegelenkfunktion anhand des KSS [22,23]. Die Analyse zeigte, dass nach 3 Monaten postoperativ kein signifikanter Unterschied bestand (Heterogenität über 75 %; ▶ Abb.…”

Section: Analgetikabedarfunclassified

Influence of the Tourniquet on Pain and Function in Total Knee Arthroplasty: a Systematic Review and Meta-Analysis

et al. 2019

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Background The use of the tourniquet in total knee arthroplasty is still a subject of controversial discussion. Previous studies mainly focus on parameters like blood loss and operation time. The aim of this systematic review is to evaluate the postoperative outcome involving parameters such as pain intensity, analgesic consumption, knee function and complication rate with and without tourniquet use, to find a recommendation for future application in total knee arthroplasty. Material and Methods This review is based on the PRISMA Checklists. A systematic research was performed in PubMed using the key words “tourniquet”, “total knee arthroplasty”, “TKA” and “knee endoprosthesis” up to and including January 2018. The initial search revealed 686 Papers which were extracted by the parameters intensity of pain, analgesic consumption, function (range of motion, Hospital for Special Surgery Score, Knee Society Score) and complications (deep vein thrombosis, surgical side infection, pulmonary embolism). The program Review Manager Version 5.3 was used for statistical analysis. A significance level of p < 0,05 was defined. Results 18 studies were included in this review with 1279 total knee arthroplasties overall (646 with the use of tourniquet and 633 without). The analysis shows a significant lower pain intensity until the fifth postoperative day (p = 0,03) and also after one to three months (p = 0,04) without using the tourniquet. Range of motion is significantly higher in two to three days postoperatively (p < 0,00 001) when the surgery was performed without tourniquet. Knee Society Score shows no difference between the two groups. A deep vein thrombosis appears significantly more often when using a tourniquet (p = 0,04). There was no higher occurrence in pulmonary embolism and surgical side infections. Conclusion The use of a pneumatic tourniquet in total knee arthroplasty affects especially the early postoperative pain and functional recovery.

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Effects of Unilateral Tourniquet Used in Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty

Abstract: Tourniquet use in bilateral TKA can reduce intraoperative time but was associated with a higher incidence of wound complications and larger postoperative knee swelling.

Cited by 28 publications

References 25 publications

Effects of tourniquet application on enhanced recovery after surgery (ERAS) and ischemia-reperfusion post-total knee arthroplasty: Full- versus second half-course application

Effects of tourniquet application on enhanced recovery after surgery (ERAS) and ischemia-reperfusion post-total knee arthroplasty: Full- versus second half-course application

Time to reconsider the routine use of tourniquets in total knee arthroplasty surgery

Influence of the Tourniquet on Pain and Function in Total Knee Arthroplasty: a Systematic Review and Meta-Analysis

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