The effects of tourniquet use in total knee arthroplasty: a randomized, controlled trial

Wang, Kai; Ni, Songjia; Li, Zhichang; Zhong, Qunjie; Li, Rujun; Hu, Li; Ke, Yan; Lin, Jianhao

doi:10.1007/s00167-015-3964-2

Cited by 76 publications

(75 citation statements)

References 29 publications

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“…With regard to the surgery-related factors, we identified that tourniquet use (both full-time and part-time use) is a strong risk factor for ALBT in TKA. This is consistent with the findings of a large number of previous studies [29][30][31] showing that tourniquet use could reduce intraoperative blood loss but would cause greater postoperative blood loss and hidden blood loss. As reported by several meta-analyses, drain use was also found to be a risk factor for ALBT.…”

Section: Discussionsupporting

confidence: 92%

Analysis of a large data set to identify predictors of blood transfusion in primary total hip and knee arthroplasty

Huang

Xie

et al. 2018

Transfusion

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Section: Discussionsupporting

confidence: 92%

Analysis of a large data set to identify predictors of blood transfusion in primary total hip and knee arthroplasty

Huang

Xie

et al. 2018

Transfusion

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“…In 5 studies, the effect on straight leg raise (SLR) was reported to be better in the first days after TKA when either no tourniquet was used or was used for only a short period [10, 13, 17–19]. In addition, a meta-analysis provided evidence of the positive effect on knee flexion when surgery was performed without a tourniquet [9].…”

Section: Introductionmentioning

confidence: 99%

A small difference in recovery between total knee arthroplasty with and without tourniquet use the first 3 months after surgery: a randomized controlled study

Alexandersson

Wang

Eriksson

2018

Knee Surg Sports Traumatol Arthrosc

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PurposeWhen a tourniquet is used during surgery on the extremities, the pressure applied to the muscles, nerves and blood vessels can cause neuromuscular damage that contributes to postoperative weakness. The hypothesis was that the rehabilitation-related results would be improved if total knee arthroplasty (TKA) is performed without the use of a tourniquet.Methods81 patients with osteoarthritis of the knee who underwent TKA surgery were randomized to surgery with or without tourniquet. Active flexion and extension of the knee, pain by visual analog scale (VAS), swelling by knee circumference, quadriceps function by straight leg raise, and timed up and go (TUG) test results were measured before and up to 3 months after surgery.ResultsANCOVA revealed no between-groups effect for flexion of the knee at day 3 postsurgery. Compared with the tourniquet group, the nontourniquet group experienced elevated pain at 24 h, with a mean difference of 16.6 mm, p = 0.005. The effect on mobility (TUG test) at 3 months was better in the nontourniquet group, with a mean difference of -1.1 s, p = 0.029.ConclusionsThe hypothesis that the rehabilitation-related results would be improved without a tourniquet is not supported by the results. When the results in this study for surgery performed with and without tourniquet are compared, no clear benefit for either procedure was observed, as the more pain exhibited by the nontourniquet group was only evident for a short period and the improved mobility in this group was not at a clinically relevant level.Level of evidenceInconsistent results, Level II.

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“…Some researchers support a shorter duration of tourniquet use to minimize the incidence of postoperative complications. Wang et al compared the difference of using a tourniquet for a short and long period of time 53 . They found that longer use of the tourniquet reduced total blood loss, where shorter use helped decrease pain and limb swelling, and promoted functional recovery after the operation.…”

Section: Tourniquetmentioning

confidence: 99%

Perioperative Blood Management Strategies for Total Knee Arthroplasty

Lü

Peng

Zhou

et al. 2018

Orthopaedic Surgery

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Total knee arthroplasty (TKA) often causes a significant amount of blood loss with an accompanying decline in hemoglobin and may increase the frequency of allogeneic blood transfusion rates. Unfortunately, allogeneic blood transfusions have associated risks including postoperative confusion, infection, cardiac arrhythmia, fluid overload, increased length of hospital stay, and increased mortality. Other than reducing the need for blood transfusions, reducing perioperative blood loss in TKA may also minimize intra-articular hemorrhage, limb swelling, and postoperative pain, and increase the range of motion during the early postoperative period. These benefits improve rehabilitation success and increase patients' postoperative satisfaction. Preoperative anemia, coupled with intraoperative and postoperative blood loss, is a major factor associated with higher rates of blood transfusion in TKA. Thus, treatment of preoperative anemia and prevention of perioperative blood loss are the primary strategies for perioperative blood management in TKA. This review, combined with current evidence, analyzes various methods of blood conservation, including preoperative, intraoperative, and postoperative methods, in terms of their effectiveness, safety, and cost. Because many factors can be controlled to reduce blood loss and transfusion rates in TKA, a highly efficient, safe, and cost-effective blood management strategy can be constructed to eliminate the need for transfusions associated with TKA.

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The effects of tourniquet use in total knee arthroplasty: a randomized, controlled trial

Abstract: I.

Cited by 76 publications

References 29 publications

Analysis of a large data set to identify predictors of blood transfusion in primary total hip and knee arthroplasty

Analysis of a large data set to identify predictors of blood transfusion in primary total hip and knee arthroplasty

A small difference in recovery between total knee arthroplasty with and without tourniquet use the first 3 months after surgery: a randomized controlled study

Perioperative Blood Management Strategies for Total Knee Arthroplasty

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