The Effects of Tourniquet Application in Total Knee Arthroplasty on the Recovery of Thigh Muscle Strength and Clinical Outcomes

Ayık, Ömer; Demіrel, Mehmet; Birişik, Fevzi; Erşen, Ali; Balcı, Halil İbrahim; Şahinkaya, Türker; Batıbay, Sefa Giray; Öztürk, İrfan

doi:10.1055/s-0040-1701454

Cited by 19 publications

(20 citation statements)

References 22 publications

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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: 87%

“…Three trials (including a total of 296 patients) met all methodological criteria for low risk of bias. 15 , 16 , 35 The other trials had sources of bias including unclear risk of selection bias, performance bias, and detection bias, as blinding was not clearly stated in the methodology or protocol. A risk of bias summary is shown in Figure 2 .…”

Section: Resultsmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 87%

Section: Resultsmentioning

confidence: 99%

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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“…Thigh pain has been considered a minor complication after tourniquet use. However, thigh pain following TKA surgery has been one of the most common early postoperative complaints, and can contribute to patient dissatisfaction after TKA [1,3,15,16]. In a prospective randomized controlled study which compared tourniquet use versus non-tourniquet use in TKA, results showed reduced thigh pain in the non-tourniquet group on postoperative day 4 [1].…”

Section: Discussionmentioning

confidence: 99%

“…In many orthopedic surgeries, the pneumatic tourniquet is efficiently used to achieve a bloodless surgical field. It decreases total blood loss during surgery, facilitates cementation, and decreases operative time [1][2][3], especially in total knee arthroplasties (TKAs). The conventional tourniquet pressure in TKAs is approximately 300-350 mmHg.…”

Section: Introductionmentioning

confidence: 99%

Elastic pneumatic tourniquet cuff can reduce postoperative thigh pain after total knee arthroplasty: a prospective randomized trial

Park

Kim

Lee

2020

BMC Musculoskelet Disord

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Background: Tourniquet use is associated with complications such as thigh pain, skin problems, and deep vein thrombosis (DVT). This prospective study aimed to evaluate the efficacy and safety of the pneumatic tourniquet system using an elastic cuff and limb occlusion pressure (LOP) in total knee arthroplasty (TKA). The hypothesis of this study was that an elastic cuff tourniquet would result in less postoperative thigh pain after TKA. Methods: This prospective randomized controlled trial involved a total of 98 patients who underwent primary TKA. They were randomized into two groups: tourniquet system using an elastic cuff and LOP group (Group E) and tourniquet system using a conventional-cuff and LOP group (Group C). Outcomes including postoperative thigh pain assessed using a visual analog scale (VAS), serum muscle enzymes, recommended tourniquet pressure (RTP), bloodlessness of surgical field, surgical time, incidence of DVT, and the frequency of rescue analgesic use after surgery, were compared between groups. Results: Patients in Group E experienced significantly less thigh pain compared to those in Group C on postoperative day 4 (P = 0.01) and day 7 (P = 0.04). The difference between RTP and systolic blood pressure was significantly lower in Group E (P = 0.045). One case of thigh DVT was found in Group E, while no such cases were found in Group C. One and two cases of poor bloodless surgical fields were observed in Group E and Group C, respectively. There was no significant difference in surgical time, levels of serum muscle enzymes, and the frequency of rescue analgesic use between the two groups. Conclusions: The pneumatic tourniquet system using an elastic cuff and LOP reduced early postoperative thigh pain more effectively than did the tourniquet system using a conventional cuff and LOP. Trial registration: #KCT0003149. Registered August 17, 2018-Retrospectively registered.

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“…Indeed, tourniquet use after TKA can provoke various complications, including a higher rate of deep vein thrombosis (DVT), wound infections, and nerve damage [10]. A recent study has shown that tourniquet application can decrease muscle strength and reduce knee range of motion (ROM), thus interfering with functional recovery after TKA [11].…”

Section: Introductionmentioning

confidence: 99%

Hemostatic effect of tourniquet combined with tranexamic acid in total knee arthroplasty: a network meta-analysis

et al. 2020

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Background There are various techniques to reduce blood loss in total knee arthroplasty (TKA), including the use of a tourniquet and tranexamic acid (TXA). In this study, we studied the combined effect of TXA with a tourniquet on blood loss in the setting of primary TKA. Methods Randomized controlled trials (RCTs) of nine treatment methods were included (placebo, intravenous [i.v.] TXA, topical TXA, i.v.-combined topical TXA, oral TXA, placebo + tourniquet, i.v. TXA +tourniquet, topical TXA + tourniquet, and i.v.-combined topical TXA + tourniquet). The patients were divided into eight groups according to the different treatment strategies, with 30 cases per group. The differences in the total blood volume, the number of patients transfused, the hemoglobin before and after the operation, and complications after the operation were compared. Results Totally 15 RCTs meeting our inclusion criteria were collected in this study. Compared with the placebo + tourniquet group, the i.v. TXA + tourniquet group displayed lower hemoglobin reduction value, pulmonary embolism (PE) incidence, total blood loss, and blood transfusion risk; the topical TXA + tourniquet group showed reduced PE incidence, total blood loss, and blood transfusion risk, and the i.v.-combined topical TXA and i.v.-combined topical TXA + tourniquet groups showed decreased total blood loss and lower blood transfusion risk. Retrospective clinical study results also demonstrated that the efficacy of i.v.-combined topical TXA was the best. Conclusions Our meta-analysis indicates that i.v.-combined topical TXA provides a low total blood loss without increasing the blood transfusion risk in patients undergoing total knee replacement surgery.

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The Effects of Tourniquet Application in Total Knee Arthroplasty on the Recovery of Thigh Muscle Strength and Clinical Outcomes

Cited by 19 publications

References 22 publications

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

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

Elastic pneumatic tourniquet cuff can reduce postoperative thigh pain after total knee arthroplasty: a prospective randomized trial

Hemostatic effect of tourniquet combined with tranexamic acid in total knee arthroplasty: a network meta-analysis

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