Quadriceps Strain and TKA: Contribution of the Tourniquet and Intramedullary Rod to Postoperative Thigh Pain

Stocks, Gregory W.; Odoemene, Melissa; Gex, Julia; Vidal, Emily A.; Sawyer, Kathryn; Jones, Stephen L; Thompson, Brandon L.; Laughlin, Mitzi S.

doi:10.2106/jbjs.22.00703

Cited by 3 publications

(1 citation statement)

References 16 publications

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“…With regard to patellar resurfacing, a systematic review and meta-analysis of RCTs revealed that resurfacing reduced anterior knee pain and revision risk compared with no resurfacing 45 . A prospective study showed that 75% of patients reported thigh pain on postoperative day 1 regardless of tourniquet or intramedullary guide use during the surgical procedure, but, at 2 weeks postoperatively, tourniquet use appeared to increase the odds of a quadriceps strain 46 . Another RCT demonstrated that the placement or length of the surgical incision did not significantly affect the rate of postoperative numbness.…”

Section: Surgical Techniquementioning

confidence: 99%

What’s New in Adult Reconstructive Knee Surgery

Villa,

Hosseinzadeh,

Higuera-Rueda

2023

Journal of Bone and Joint Surgery

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In the current Guest Editorial, we evaluate and summarize the most relevant findings from recent, meaningful, peer-reviewed publications in different research areas. Articles at various Levels of Evidence were included, but increased attention was paid to Level-I and award-winning reports. EconomicsConsiderable debate continues with regard to the economics of reconstructive knee surgery. An updated Medicare projection revealed that, by 2040, the annual number of revision total knee arthroplasties (TKAs) performed would be 115,147, whereas, by 2060, it would be 286,740. These values are important for understanding the future health-care resource utilization involving revision TKA, which is only expected to increase 1 . A secondary analysis of a randomized clinical trial (RCT) evaluating health-care resource utilization up to 12 months after primary TKA, among dissatisfied and satisfied patients, showed that patients dissatisfied with their return to function incurred a mean cost of $19,007.70, compared with $13,523.83 for satisfied patients (p = 0.07). Although the cost difference was not significant, its magnitude deserves attention 2 . Data from the New Zealand Joint Registry indicated that patients undergoing TKA have a mortality rate 8% higher than that of the general population 3 . Assessing mortality after primary TKA is relevant for future economic analyses.

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Section: Surgical Techniquementioning

confidence: 99%

What’s New in Adult Reconstructive Knee Surgery

Villa,

Hosseinzadeh,

Higuera-Rueda

2023

Journal of Bone and Joint Surgery

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Tourniquet Effect on Patients Undergoing Total Knee Arthroplasty: A Single‐Blind, Randomized Controlled Trial

Dong,

Li,

Xue

et al. 2024

Orthopaedic Surgery

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BackgroundTourniquet is applied in Total Knee Arthroplasty (TKA) to reduce intraoperative blood loss and improve view of surgical field. However, tourniquet use in TKA is still in dispute. Some researchers find that tourniquet may lead to extra side effects such as aggravated pain and limb swelling, while others consider that tourniquet has no significant adverse impact on clinical outcomes of TKA patients. This trial is conducted to evaluate tourniquet effect on TKA patients.MethodsA prospective, single‐blind, randomized controlled trail is adopted with a sample size of 130 knees from August 2020 to February 2023. Patients undergoing TKA are randomly allocated to tourniquet group and non‐tourniquet group. Outcomes including quadriceps thickness and stiffness, operation time, total blood loss, intraoperative blood loss, postoperative blood loss, transfusion rate, thigh circumference, knee and thigh VAS, D‐Dimer and CRP level, knee function score, patient satisfaction, and complications are evaluated in this trial. Student's t‐test, Mann–Whitney U test, Pearson's chi‐square test, and Fisher's exact test are used in this study.ResultsNo significant difference in demographic information and baseline outcomes were found (p > 0.05). Participants in the tourniquet group had significantly less total blood loss and intraoperative blood loss, more postoperative blood loss, and higher D‐Dimer level on postoperative day 3 when compared with non‐tourniquet group (p < 0.05). Other outcomes including quadriceps thickness and stiffness, operation time, postoperative blood loss, transfusion rate, thigh circumference, knee and thigh VAS, D‐Dimer level on postoperative day 1, CRP level, knee function score, patient satisfaction, and complications showed no significant difference (p > 0.05).ConclusionTourniquet application can effectively reduce intraoperative blood loss and total blood loss, without significant side effects. Hence, we advocate the regular use of tourniquet in primary TKA.

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Postoperative Complications and Readmission Rates in Robotic-Assisted Versus Manual Total Knee Arthroplasty: Large, Propensity Score–Matched Patient Cohorts

Howell,

Witvoet,

Scholl

et al. 2024

J Am Acad Orthop Surg

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Introduction: There is a paucity of research comparing postoperative complication rates between manual total knee arthroplasty (M-TKA) and robotic-assisted total knee arthroplasty (RA-TKA). This study aims to compare 90-day postoperative complication, readmission, and emergency department rates between RA-TKA and M-TKA. Methods: A retrospective review of a multihospital database identified patients who underwent TKA between January 2016 and May 2023. Surgeons who used the robotic-assisted surgery technique in <10% or >90% of their cases annually were excluded. This resulted in 15,999 cases (8,853 RA-TKAs; 7,146 M-TKAs) from 282 surgeons. RA-TKA and M-TKA cohorts were one-to-one matched based on patient sex, age, body mass index, hospital setting, surgeon experience, primary payer, and anesthesia type. Each cohort consisted of 7,146 patients (N = 14,292). 90-day revisits, specifically readmissions, readmissions with >23 hours of observation, and ED visit rates were compared between cohorts. Complications were classified according to the Clinical Classification Software schema and compared between cohorts. Mann-Whitney U, chi-squared, and Fisher exact tests, along with Bonferroni correction, were used to statistically compare cohorts. Results: All-cause 90-day readmission rates were 2.4% for RA-TKA and 2.6% for M-TKA (P = 0.36). RA-TKA had fewer revisits (RA-TKA: 7.8%; M-TKA: 8.8%, P = 0.027) and rates of readmission with >23 hours of observation (RA-TKA: 1.4%; M-TKA: 2.0%, P = 0.003). RA-TKA had fewer hospital revisits due to joint stiffness (RA-TKA: 17 revisits; M-TKA: 42 revisits, P = 0.002) and chronic pain (RA-TKA: 1 revisit; M-TKA: 8 revisits, P = 0.039). Fewer readmissions were observed for acute injuries (lower extremity muscle/tendon strains) in the RA-TKA cohort (RA-TKA: 1; M-TKA: 9, P = 0.021). RA-TKA had fewer ED visits due to hematomas (RA-TKA: 0 visits; M-TKA: 7 visits, P = 0.016). Conclusion: In this retrospective matched cohort analysis, RA-TKA was associated with markedly fewer revisits and readmissions with >23 hours of observation compared with M-TKA. No differences in all-cause 90-day readmission were observed between cohorts. Level of Evidence: Level III Study Design: Retrospective review.

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Quadriceps Strain and TKA: Contribution of the Tourniquet and Intramedullary Rod to Postoperative Thigh Pain

Cited by 3 publications

References 16 publications

What’s New in Adult Reconstructive Knee Surgery

What’s New in Adult Reconstructive Knee Surgery

Tourniquet Effect on Patients Undergoing Total Knee Arthroplasty: A Single‐Blind, Randomized Controlled Trial

Postoperative Complications and Readmission Rates in Robotic-Assisted Versus Manual Total Knee Arthroplasty: Large, Propensity Score–Matched Patient Cohorts

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