The effect of tourniquet usage on cement penetration in total knee arthroplasty

Abstract

Background:It is a randomized study to compare cement penetration on x-rays after total knee arthroplasty (TKA) among 3 different ways to use tourniquets; application during the surgery, application only with implantation prosthesis and with no tourniquet use.Methods:A total 69 knees of 59 patients were included in the study in a quasirandom manner. Each patient had physical exams and standard radiographic evaluations at 6 weeks after the TKA procedure. Outcome evaluations included visual analog scale (VAS) scores, Knee Society Scores (KSS), blood transfusion, and drainage status after surgery for all groups. For radiographic review, the tibial plateau was divided into zones in the anterior–posterior and lateral views, according to the Knee Society Scoring System.Results:The average age of the patients who were eligible for the study was 65.05 (range 46–81) years. All 59 patients included in the study were female patients. Group 1 consisted of 24 patients who had TKA with use of a tourniquet during the entire operation. Group 2 consisted of 20 patients who had TKA with use of tourniquet only at the time of cementing and group 3 consisted of 25 patients with no use tourniquet. There is no significant difference in early cement penetration among the groups (group 1 2.50 mm, group 2 2.28 mm, group 3 2.27 mm; group 1 vs 2 P = .083, group 1 vs 3 P = .091, group 2 vs 3 P = .073). There is no significant difference for postoperative drainage among the 3 groups (group 1 245 mL, group 2 258.76 mL, group 3 175.88 mL; group 1 vs 2 P = .081, group 1 vs 3 P = .072, group 2 vs 3 P = .054). There was no need to transfuse more than 1 unit in any patient. The VAS score was significantly higher (group 1 3.58, group 2 1.55, group 3 1.52; group 1 vs 2 P = .022, group 1 vs 3 P = .018, group 2 vs 3 P = .062) and KSS was significantly lower in the tourniquet group (group 1 63, group 2 79, group 3 82; group 1 vs 2 P = .017, group 1 vs 3 P = .02, group 2 vs 3 P = .082).Conclusion:We do not suggest long-duration tourniquet use, which can lead higher pain scores and reduce functional recovery after total knee arthroplasty.

Does tourniquet use affect the periprosthetic bone cement penetration in total knee arthroplasty? A meta-analysis

“…Four studies provided data on the calculated blood loss [14,18,21,22]. We found no major difference in calculated blood loss between the four groups (WMD = 12.07, 95%CI = (− 78.63 to 102.77); p = 0.79, I 2 = 99%) (Fig.…”

“…Four studies reported on the VAS knee pain scores [14,18,21,22]. Pooled results showed that tourniquet use increased postoperative pain (WMD = 1.34, 95% CI = (0.32 to 2.36), p = 0.01, I 2 = 98%) ( Fig.…”

“…Some studies have found that the use of tourniquets causes an increase in cement penetration due to loss of the blood and fat in the cancellous bone during bonding [13,14]. However, there are also studies that suggest that tourniquet use does not affect cement mantle penetration [15][16][17][18], further clouding the issue. It is unclear whether the use of tourniquets can increase the thickness of the bone cement around the tibial prosthesis and indirectly improve the stability and durability of the prosthesis.…”

Does Tourniquet Use in TKA Increase Postoperative Pain? A Systematic Review and Meta-analysis

“…TKA remains one of the most widely performed orthopaedic surgical procedures, and tourniquet use has been considered an important element of the operation since it first was developed. More recently, however, the once highly regarded advantages of tourniquet use-achieving a bloodless field for visualization and cement interdigitation [3,10,25,28,30,31] -have come under great scrutiny in light of its potential disadvantages. Indeed, avoiding the use of a tourniquet in TKA (so as to prevent complications such as pain and improve on important patient outcomes like ROM and LOS) has been proposed and debated heavily [23,32].…”

Dolor Postoperatorio Asociado Al Uso De Isquemia en Los Pacientes De Cirugia Ortopedica

“…En un estudio aleatorizado para comparar la penetración de cemento en las radiografías después de la artroplastia total de rodilla (ATR) se realizaron 3 grupos en los cuales el torniquete tenía diferentes usos; el primero fue su aplicación durante la cirugía, el segundo la aplicación solo con prótesis de implantación y el tercero sin uso de torniquete, este estudio concluye que el uso de torniquetes en periodos largos, pueden producir puntuaciones más altas de dolor y reducir la recuperación funcional después de la artroplastia total de rodilla 14 .…”