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

Tuncalı, Bahattin; Boya, Hakan; Kayhan, Zeynep; Araç, Şükrü

doi:10.5606/ehc.2018.57973

Cited by 7 publications

(5 citation statements)

References 25 publications

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“…The need for larger dissection, inadequate oxygenation of the tissue and subsequent necrosis, aggressive use of retractors, longer surgery duration, poor immunity and problems with prophylactic antibiotic dosing also appear as reasons for inferior outcome in the literature. 9,[19][20][21] However, there is an emerging view that these problems are based on the distribution of peri-incisional subcutaneous fat tissue and not on BMI alone. As BMI does not account for fat tissue distribution it may not, for instance, adequately portray the difference between a healthy, muscular person with short stature and a heavy and tall person.…”

Section: Discussionmentioning

confidence: 99%

Novel radiographic hip fat thickness ratio correlates with early re-operation following total hip arthroplasty

et al. 2021

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Introduction: Obesity is thought to lead to increased failure rates following total hip arthroplasty (THA). Site-specific fat distribution has been suggested to be a better indicator of risk, compared to body mass index. Fat thickness measurement methods were developed for total knee arthroplasty, however, there is limited data on the methods for THA. The aim of this study was to assess the interobserver and intraobserver reliability of a newly defined radiographic subcutaneous fat thickness ratio and investigate the correlation of this ratio with early failure following THA. Methods: 321 patients who underwent primary THA at a single institution between 2014 and 2017, with at least 1-year of follow-up and a preoperative pelvis anteroposterior x-ray radiograph were included in this study. A high hip fat thickness ratio (HFTR) was arbitrarily defined as ⩾2. Early failure was defined as revision or re-operation for any reason and death related to operation first year following THA. Results: The HFTR was shown to have excellent intraobserver and interobserver reliability. High HFTR was associated with higher risk of early failure following THA (odds ratio 3.8, [95% confidence interval, 1.2–12.1], p < 0.05). The same association persisted when HFTR was analysed as a continuous variable ( p < 0.01) and in multivariate analysis ( p < 0.05). Conclusions: HFTR can be used to assess periarticular soft tissue distribution and may be regarded as a useful and reproducible tool for assessing risk of early failure following THA.

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Section: Discussionmentioning

confidence: 99%

Novel radiographic hip fat thickness ratio correlates with early re-operation following total hip arthroplasty

et al. 2021

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“…Although high‐ quality evidence is conflicting regarding whether the use of a tourniquet increases the risk of venous thromboembolism, tourniquets also should be used with caution in patients with an increased risk or history of this condition 1,3 . Moderate‐quality evidence is conflicting regarding whether body mass index is predictive of injury risk when a tourniquet is used; however, these devices should be used with caution in patients with a high body mass index 4,5 . Low‐quality evidence is conflicting regarding if tourniquet use in patients older than 60 years increases the risk of poor muscle recovery or other complications; although, in one study, there were no complications when the tourniquet fit well 4,6 .…”

Section: Preoperative Evaluationmentioning

confidence: 99%

Guideline for pneumatic tourniquet safety

Croke¹

2020

AORN Journal

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“…Numerous factors were described, including delay in entry point localization, technical know-how, complication rates, bleeding, and increased length of hospital stay. [ 5 , 6 ]…”

Section: Introductionmentioning

confidence: 99%

“…Numerous factors were described, including delay in entry point localization, technical know-how, complication rates, bleeding, and increased length of hospital stay. [5,6] Numerous reports exist on the fixation technique of IMN in patients with obesity, but there has been little focus to identify the effects of obesity on fracture union. [7] Based on the available literature, obesity affects bone metabolism through several mechanisms.…”

mentioning

confidence: 99%

Does obesity affect diaphyseal femoral fracture healing treated with intramedullary locking nail?

Issace¹,

Singh

Sisubalasingam

et al. 2022

Jt Dis Relat Surg

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Objectives This study aims to evaluate the effect of obesity on radiological fracture union in diaphyseal femoral fractures (DFFs) treated with intramedullary nailing (IMN). Patients and methods Between January 2017 and December 2018, a total of 120 patients (101 males, 19 females; mean age: 35.1±3.0 years; range, 18 to 72 years) treated with IMN for closed DFFs were retrospectively analyzed. Data including age, sex, location, weight, height, comorbidities such as diabetes mellitus, hypertension or kidney injury, date of injury, mechanism of injury, type of femoral fractures (AO classification), date of surgery, duration of surgery, IMN length and diameter used, date of radiological fracture union and complications of surgery such as nonunion, delayed union, and infections were recorded. Results Of the patients, 63 had obesity and 57 did not have obesity. There was a statistically significant difference in fracture configuration among patients with obesity; they sustained type B (p=0.001) and type C (p=0.024), the most severe fracture configuration. The nonunion rate was 45%. Obesity had a significant relationship with fracture nonunion with patients with obesity having the highest number of nonunion rates (n=40, 74.1%) compared to those without obesity (n=14, 25.9%) (p=0.001). Fracture union was observed within the first 180 days in 78.9% of patients without obesity, while it developed in the same time interval in only 38.1% of patients with obesity (p=0.001). Conclusion Fracture union time for the patients with obesity was longer, regardless of the fracture configuration. Obesity strongly affects fracture union time in DFFs treated with an IMN. Obesity should be considered a relative risk in decisionmaking in the choice of fixation while treating midshaft femoral fractures.

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

Abstract: Compared to non-obese patients, higher tourniquet inflation pressure is required in obese patients during TKA due to their wider extremity circumference and higher systolic blood pressure profile.

Cited by 7 publications

References 25 publications

Novel radiographic hip fat thickness ratio correlates with early re-operation following total hip arthroplasty

Novel radiographic hip fat thickness ratio correlates with early re-operation following total hip arthroplasty

Guideline for pneumatic tourniquet safety

Does obesity affect diaphyseal femoral fracture healing treated with intramedullary locking nail?

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