The tourniquet in total knee arthroplasty

Eyres, K. S.; Sharpe, IT; Abdel-Salam, A.

doi:10.1302/0301-620x.81b5.0810932

Cited by 19 publications

(28 citation statements)

References 1 publication

(3 reference statements)

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“…Sherman et al [28] stated patients who had a tourniquet time of 60 min or longer as high risk group using an analysis of complications in 2640 cases after arthroscopic cases. Abdel-Salam and Eyres [1] and Jarolem et al [15] have shown clinical advantages for TKA surgery without the use of tourniquets. Nevertheless, a pneumatic tourniquet is commonly used in knee to provide a clean, dry Ideally, the tourniquet should be applied at the lowest pressure and for the shortest amount of time possible.…”

Section: Discussionmentioning

confidence: 99%

A new tourniquet system that determines pressures in synchrony with systolic blood pressure in knee surgery

Ishii¹,

Noguchi²,

Takeda³

et al. 2008

Knee Surg Sports Traumatol Arthr

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This study reports the results of the clinical use of a new tourniquet system for surgery related to knee joint that can determine tourniquet pressure in synchrony with systolic blood pressure (SBP). We prospectively applied additional pressure of 100 mmHg based on the SBP recorded just before infiltration of tourniquet in 163 consecutive procedures, which consisted of 73 TKA related surgeries, 42 arthroscopic related surgeries, 20 ACL reconstructed surgeries, 15 ORIF, and 13 other surgeries. After the infiltration, the tourniquet pressure was automatically synchronized with the SBP. The interval of the measurement of blood pressure was every 2.5 min. The average durations of the operation and tourniquet use were 56 (range 6-134) and 56 (range 8-125) min, respectively. The average initial systolic tourniquet pressure was 207 mmHg (range 178-302). The average maximum changes during surgery were 37 mmHg (range 2-102) systolic and 23 mmHg (range 5-67) diastolic. The average maximum systolic pressure changes during 2.5 min interval were 20 mmHg (range 5-97). All cases kept a good operative field without measurable bleeding and there were no postoperative complications. Sixty-eight (42%) cases had a lower intra-operative SBP than the initial value. Since a tourniquet should be applied at the lowest pressure, and for the shortest amount of time possible, the new system appears to be practical and reasonable for maintaining a bloodless surgical field, as compared to conventional tourniquets, which maintain the initial pressure between 300 and 350 mmHg.

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Section: Discussionmentioning

confidence: 99%

A new tourniquet system that determines pressures in synchrony with systolic blood pressure in knee surgery

Ishii¹,

Noguchi²,

Takeda³

et al. 2008

Knee Surg Sports Traumatol Arthr

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show abstract

“…Several randomized controlled trials and meta-analyses have been performed in arthroplasty patients, with many demonstrating worse pain scores and worse functional outcomes with tourniquet use [5][6][7][8][22][23][24][25][26][27][28][29][30][31][32][33][34]40 ; however, none were powered to address more critical complications, such as the rate of reoperation [25][26][27][28][29][30][31]40 . Furthermore, the potential for adverse effects as a result of tourniquet use may be higher in the case of traumatic injury.…”

Section: Discussionmentioning

confidence: 99%

“…Several small studies in humans have demonstrated observable oxidative muscle damage following shorter tourniquet duration [19][20][21][22] . Numerous small studies have been performed in knee arthroplasty patients and have shown worse pain scores and worse functional outcomes following the use of a tourniquet [5][6][7][8][22][23][24][25][26][27][28][29][30][31][32][33][34] . However, none of these studies were powered to address complication rates.…”

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confidence: 99%

Effect of Tourniquet Use During Surgical Treatment of Open Fractures

Gitajn

Werth

Sprague

et al. 2021

Journal of Bone and Joint Surgery

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UpdateThis article was updated on September 24, 2021, because of a previous error. On page 864, in the final rowof Tables III and IV,text that had read “Gustilo Type IIIA and tourniquet use” now reads “Gustilo Type IIIB and tourniquet use.”.An erratum has been published: J Bone Joint Surg Am. 2021 November 3;103(21):e88.Background:We sought to evaluate whether tourniquet use, with the resultant ischemia and reperfusion, during surgical treatment of an open lower-extremity fracture was associated with an increased risk of complications.Methods:This is a retrospective cohort study of 1,351 patients who had an open lower-extremity fracture at or distal to the proximal aspect of the tibia and who participated in the FLOW (Fluid Lavage of Open Wounds) trial. The independent variable was intraoperative tourniquet use, and the primary outcome measures were adjudicated unplanned reoperation within 1 year of the injury and adjudicated nonoperative wound complications.Results:Unplanned reoperation and nonoperative wound complications were roughly even between the no-tourniquet (18.7% and 19.1%, respectively) and tourniquet groups (17.8% and 20.8%) (p = 0.78 and p = 0.52). Following matching, as determined by model interactions, tourniquet use was a significant predictor of unplanned reoperation in Gustilo Type-IIIA (odds ratio, 3.60; 95% confidence interval, 1.16 to 11.78) and IIIB fractures (odds ratio, 16.61; 95% confidence interval, 2.15 to 355.40).Conclusions:The present study showed that tourniquet use did not influence the likelihood of complications following surgical treatment of an open lower-extremity fracture. However, in cases of severe open fractures, tourniquet use was associated with increased odds of unplanned reoperation; surgeons should be cautious with regard to tourniquet use in this setting.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…A successful total knee TKA depends on good operation and postoperative recovery. [21][22][23] Ejaz et al showed that TKA without tourniquet use results in better functional and clinical outcomes. 24 Quadriceps muscle function is very important in knee The powers of the performed tests (0.050) were below the desired power of 0.800.…”

Section: Discussionmentioning

confidence: 99%

A comparative study of the hemodynamic and clinical effects of using or not tourniquet in total knee arthroplasty

Hung

Chiu

Cheng

2023

Journal of the Chinese Medical Association

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Background: Pneumatic tourniquet is widely used in lower limb surgery to provide a bloodless operating field. Previous studies on total knee arthroplasty (TKA) in which tourniquets have been applied during surgery have reported some vascular and soft-tissue complications. Nevertheless, it is still not well known exactly how use of tourniquets contributes to hemodynamics of the lower limb and its clinical relevance following TKA. In this prospective study, we wished to determine whether tourniquet affects the hemodynamics and postoperative healing of the lower limb in the first few weeks and its clinical relevancies following TKA. Methods: We prospectively collected consecutive 110 patients with advanced osteoarthritis of the knee. All the subjects were randomly assigned to one of two TKA procedures: TKA with (Group T) or without (Group O) tourniquets. The hemodynamics of each operated leg was assessed by Doppler, first before the operation, then postoperatively on days 2, 6, 14, and 28. The operative and postoperative managements were done the same as those described in the papers done by the author. Parameters during the operative and postoperative course, including, demography, pre- or postoperative knee score, tourniquet time, operation time, estimated blood loss, perioperative blood transfusion, hospital course, and complications will all be recorded and compared in detail. All patients were measured for all response variables, which included demographic variables, results of Doppler, and important surgical outcomes. Fisher’s exact test was used to compare differences between the two groups for each discrete variable, and a Mann-Whitney Rank Sum Test was used to analyze each continuous variable. The p value was set for each test at 0.05 before analysis took place. In accordance with the repeated measures, the venous hemodynamic parameters were checked. If any significant differences appeared in the overall test, values were then compared in pairs using two sample t-tests for all statistical tests. The level of significance was set at p < 0.05. Results: In our 110 patients (55 with tourniquet, 55 without), all checked clinical parameter were without significant difference except postoperative quadriceps muscle recovery. This implied tourniquet use influenced postoperative rehabilitation program. Blood loss amount were similar in both groups. There was only one DVT found. Conclusion: Tourniquet use in TKA must be managed very carefully. Not only because of immediate complication resulted from tourniquet but also influence on post-operational functional recovery, especially in quadriceps muscle function. According to this study, TKA without tourniquet use preserves better quadriceps muscle function to provide faster recovery and less transfusion need. It avoids complications from tourniquets as well.

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The tourniquet in total knee arthroplasty

Cited by 19 publications

References 1 publication

A new tourniquet system that determines pressures in synchrony with systolic blood pressure in knee surgery

A new tourniquet system that determines pressures in synchrony with systolic blood pressure in knee surgery

Effect of Tourniquet Use During Surgical Treatment of Open Fractures

A comparative study of the hemodynamic and clinical effects of using or not tourniquet in total knee arthroplasty

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