Soft-tissue damage during total knee arthroplasty

Mayer, Constantin; Franz, Alexander; Harmsen, Jan‐Frieder; Queitsch, Fina Pauline; Behringer, Michael; Beckmann, Johannes; Krauspe, Rüdiger; Zilkens, Christoph

doi:10.1016/j.jor.2017.06.015

Cited by 21 publications

(9 citation statements)

References 80 publications

(84 reference statements)

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“…The use of a tourniquet during TKA can clear the visual field clear and facilitate surgery, but can often cause postoperative pain and discomfort in the thigh muscles of the targeted limb [ 23 ]. It had been indicated that the non-use of tourniquets during TKA can reduce muscle and soft tissue injury in the targeted limb, relieve postoperative thigh muscle pain, shorten the length of hospital stay, and thus promote the early functional recovery of the operated knee [ 24 ]. In this study, the lower limbs were lifted for 30 s to expel blood during the operation and the blood was not extruded using a blood drive belt.…”

Section: Discussionmentioning

confidence: 99%

Enhanced recovery after surgery protocols in total knee arthroplasty via midvastus approach: a randomized controlled trial

Wei

Tang

et al. 2021

BMC Musculoskelet Disord

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Background Enhanced recovery after surgery (ERAS) protocols were rapidly adopted in many surgeries such as fast-track arthroplasty. The study aimed to investigate the impact of ERAS protocols on the clinical effect of total knee arthroplasty (TKA) via the midvastus approach. Methods A total of 69 patients who underwent primary unilateral TKA via the midvastus approach from October 2018 to June 2019 were enrolled and randomly divided into two groups: ERAS group and Control group. The ERAS protocols were adopted for the ERAS group and consisted of pure juice drinking 2 h before the surgery, optimization of the preoperative anesthesia plan, phased use of tourniquets, and the use of tranexamic acid as well as a drug cocktail. The operative time, first postoperative walking time, first straight leg elevation time, postoperative hospitalization time, visual analogue scale score (VAS score), Hospital for Special Surgery score (HSS score), conventional Knee Society score (KSS), and knee range of motion (ROM) were used to assess the clinical effects in the two groups. All the included patients were followed up for 12 months. Results There were no significant differences in the basic demographic information and operation time between the ERAS and Control groups (P > 0.05). The first postoperative walking time (2.11 ± 0.11 h) and first postoperative straight leg elevation time (6.14 ± 1.73 h) in the ERAS group were significantly earlier than those in the Control group (P < 0.001) and the postoperative hospitalization time was significantly shorter (3.11 ± 0.32 days). The postoperative mean VAS scores in both groups were significantly reduced compared with those before surgery (P < 0.001). The VAS scores for the ERAS group were significantly lower than those for the Control group at 1, 2, and 7 days after surgery (P < 0.001). The mean HSS scores, KSS, and knee ROM were significantly increased in both the ERAS and Control groups at 1, 3, 6, and 12 months after surgery (P < 0.001). In addition, the HSS scores, KSS, and knee ROM in the ERAS group were significantly higher than those in the Control group at 1 month after surgery (P < 0.001). Conclusions ERAS protocols improved the clinical effects of TKA via the midvastus approach, facilitating early out-of-bed activity and comfortable postoperative rehabilitation exercise, and further increasing patient satisfaction. Trial registration ClinicalTrials.gov Identifier: NCT04873544.

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Section: Discussionmentioning

confidence: 99%

Enhanced recovery after surgery protocols in total knee arthroplasty via midvastus approach: a randomized controlled trial

Wei

Tang

et al. 2021

BMC Musculoskelet Disord

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“…For instance, tourniquets loosening or slipping resulting in an increased hemorrhage was tracked by SACM and within 30 s had identified a re-bleed from the arm site and began re-tightening the tourniquet. Initial design focused on re-tightening if the tourniquet loosened, but SACM could additionally be adapted to periodically loosen, providing re-infusion to the extremity to help manage limb survival [19][20][21]. Next, we highlighted the effect a secondary internal hemorrhage had on SACM.…”

Section: Discussionmentioning

confidence: 99%

Supervisory Algorithm for Autonomous Hemodynamic Management Systems

Snider

Vega

Ross

et al. 2022

Sensors

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Future military conflicts will require new solutions to manage combat casualties. The use of automated medical systems can potentially address this need by streamlining and augmenting the delivery of medical care in both emergency and combat trauma environments. However, in many situations, these systems may need to operate in conjunction with other autonomous and semi-autonomous devices. Management of complex patients may require multiple automated systems operating simultaneously and potentially competing with each other. Supervisory controllers capable of harmonizing multiple closed-loop systems are thus essential before multiple automated medical systems can be deployed in managing complex medical situations. The objective for this study was to develop a Supervisory Algorithm for Casualty Management (SACM) that manages decisions and interplay between two automated systems designed for management of hemorrhage control and resuscitation: an automatic extremity tourniquet system and an adaptive resuscitation controller. SACM monitors the required physiological inputs for both systems and synchronizes each respective system as needed. We present a series of trauma experiments carried out in a physiologically relevant benchtop circulatory system in which SACM must recognize extremity or internal hemorrhage, activate the corresponding algorithm to apply a tourniquet, and then resuscitate back to the target pressure setpoint. SACM continues monitoring after the initial stabilization so that additional medical changes can be quickly identified and addressed, essential to extending automation algorithms past initial trauma resuscitation into extended monitoring. Overall, SACM is an important step in transitioning automated medical systems into emergency and combat trauma situations. Future work will address further interplay between these systems and integrate additional medical systems.

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“…An intentional periodic loosening can also be integrated into the algorithm allowing for reperfusion of viable tissue distal to the TKT site. This can be beneficial for instances where prolonged TKT use is required to prevent tissue necrosis, extensive nerve damage, and potential limb preservation once surgical intervention is possible [18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Development and Characterization of a Self-Tightening Tourniquet System

Vega¹,

Hernandez-Torres²,

Berard³

et al. 2022

Sensors

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Uncontrolled hemorrhage remains a leading cause of death in both emergency and military medicine. Tourniquets are essential to stopping hemorrhage in these scenarios, but they suffer from subjective, inconsistent application. Here, we demonstrate how tourniquet application can be automated using sensors and computer algorithms. The auto-tourniquet self-tightens until blood pressure oscillations are no longer registered by the pressure sensor connected to the pneumatic pressure cuff. The auto-tourniquet’s performance in stopping the bleed was comparable to manual tourniquet application, but the time required to fully occlude the bleed was longer. Application of the tourniquet was significantly smoother, and less variable, for the automatic tourniquet compared to manual tourniquet application. This proof-of-concept study highlights how automated tourniquets can be integrated with sensors to provide a much more consistent application and use compared to manual application, even in controlled, low stress testing conditions. Future work will investigate different sensors and tourniquets to improve the application time and repeatability.

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Soft-tissue damage during total knee arthroplasty

Cited by 21 publications

References 80 publications

Enhanced recovery after surgery protocols in total knee arthroplasty via midvastus approach: a randomized controlled trial

Enhanced recovery after surgery protocols in total knee arthroplasty via midvastus approach: a randomized controlled trial

Supervisory Algorithm for Autonomous Hemodynamic Management Systems

Development and Characterization of a Self-Tightening Tourniquet System

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