Thigh pain following tourniquet application in simultaneous bilateral total knee replacement arthroplasty

Worland, Richard L.; Arredondo, Jorge; Angles, Francesesc; Lopez‐Jimenez, Francisco; Jessup, Douglas E.

doi:10.1016/s0883-5403(97)90153-4

Cited by 105 publications

(77 citation statements)

References 21 publications

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“…Others have observed pain is greater with higher tourniquet inflation pressure [59,63]. Although our examination of pain was purely descriptive (we were underpowered for a thorough statistical examination of group differences in all outcomes), the group means we observed suggest against a clinically meaningful effect of tourniquet use on postoperative pain levels.…”

Section: Discussionmentioning

confidence: 79%

Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

Dennis

Kittelson

Yang

et al. 2016

Clinical Orthopaedics &Amp; Related Research

159

148

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Background Tourniquet use during total knee arthroplasty (TKA) improves visibility and reduces intraoperative blood loss. However, tourniquet use may also have a negative impact on early recovery of muscle strength and lower extremity function after TKA. Questions/purposes The purpose of this study was (1) to determine whether tourniquet use affects recovery of quadriceps strength (primary outcome) during the first 3 postoperative months; and (2) to examine the effects of tourniquet application on secondary outcomes: voluntary quadriceps activation, hamstring strength, unilateral limb balance as well as the effect on operative time and blood loss.Methods Twenty-eight patients (mean age 62 ± 6 years; 16 men) undergoing same-day bilateral TKA (56 lower extremities) were enrolled in a prospective, randomized study. Subjects were randomized to receive a tourniquetassisted knee arthroplasty on one lower extremity while the contralateral limb underwent knee arthroplasty without extended tourniquet use. In the former group, the tourniquet was inflated just before the incision was made and released after cementation; in the latter group, a tourniquet was not used (10 of 28 [36%]) or inflated only during component cementation (18 of 28 [64%]). The choice of no tourniquet or use just during cementation was based on surgeon choice, because some surgeons felt a tourniquet during cementation was necessary to achieve a dry surgical field to maximize cement fixation. A median parapatellar approach and the One or more of the authors (DAD, CCY, TMM, RHK) has received funding from Porter Adventist Hospital, during the study period, in the amount of USD 10,000 to USD 100,000. One of the authors (DAD) has or may receive payments or benefits from DePuy (Warsaw, IN, USA) in the amount of USD more than USD 1,000,001 not related to this work. One of the authors certifies that he (RHK) has or may receive payments or benefits from Stryker (Kalamazoo, MI, USA) and Innomed (Savannah, GA, USA) in the amount of USD 100,001 to USD 1,000,001 not related to this work. One of the authors (TMM) has or may receive payments or benefits from Zimmer (Warsaw, IN, USA) in the amount of less than USD 10,000 not related to this work. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.The surgeries for this study were performed at Porter Adventist Hospital, Denver, CO, USA, and the postoperative patient te...

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Section: Discussionmentioning

confidence: 79%

Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

Dennis

Kittelson

Yang

et al. 2016

Clinical Orthopaedics &Amp; Related Research

159

148

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“…Burkart et al [4] used 300 mmHg and Stringer et al [15] 500 mmHg. A pressure of 100 mmHg above systolic blood pressure is recommended by Worland et al [18] to reduce thigh pain following tourniquet application.…”

Section: Discussionmentioning

confidence: 99%

The effect of tourniquet use in total knee arthroplasty

Vandenbussche

Duranthon

Couturier

et al. 2002

International Orthopaedics

155

152

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We conducted a prospective, randomised study on primary total knee replacements to evaluate the effects of tourniquet use on total calculated blood loss using Gross formula, post-operative measured blood loss, operating time, need for blood transfusion, post-operative pain, analgesia requirement and knee flexion. Forty patients were operated on with the use of an arterial tourniquet with pressure of 350 mmHg (group A), and 40 patients without the use of a tourniquet (group B). Total calculated blood loss was significantly increased (P=0.0165) without the use of a tourniquet. There was no significant difference in measured blood loss or operating time. The median units of blood given were similar in both groups. In spite of autologous transfusions 14% of patients received additional homologous transfusions. At 6 h post-operatively pain was significantly less (P=0.0458) in group B but was similar at 24 and 48 h. There was no significant difference in analgesia requirement. The mean change in total flexion in group B was significantly better (P<0.001) at 5 days than in group A, but knee flexion was similar at 10 days and 3 months. Knee arthroplasty operations without the use of a tourniquet cause a greater blood loss but have only small benefits in the early post-operative period.Résumé Une étude prospective et randomisée a été réali-sée sur 80 arthroplasties totales du genou consécutives de première intention dans le but d'évaluer l'effet de l'utilisation du garrot pneumatique sur les pertes sanguines totales calculées selon la formule de Gross, les pertes sanguines mesurées par drainage aspiratif, la durée opératoire, la né-cessité de transfusion sanguine, la douleur post-opératoire, le besoin d'antalgique et la récupération de la flexion du genou. Quarante patients ont été opérés avec un garrot pneumatique gonflé à 350 mmg (group A), et quarante sans garrot pneumatique (group B). Les pertes sanguines totales calculées étaient plus élevées de façon significative (P=0.0165) dans le groupe B. Il n'y avait pas de différence significative entre les deux groupes sur les pertes sanguines mesurées par drainage aspiratif et la durée opératoire. Le nombre de culots globulaires nécessaire était le même dans les deux groupes. Malgré un protocole d'autotransfusion, 14% des patients ont eu une transfusion homologue complémentaire. La douleur post-opératoire était significativement moindre (P=0.0458) à la sixième heure dans le groupe B mais était identique à 24 et 48 heures. Il n'y avait pas de différence sur la consommation d'antalgique. La flexion dans le groupe B était meilleure (P<0.001) au cinquième jour que dans le groupe A, mais était identique à 10 jours et au troisième mois post-opératoire pour les deux groupes. La non-utilisation d'un garrot pneumatique apporte quelques bénéfices dans la période post-opératoire immédiate mais est responsable d'une majoration des pertes sanguines totales calculées. IntroductionDespite progress in pre-operative autologous donation, intraoperative normovolaemic haemodilution and...

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“…The manual process however is both time consuming and labor intensive and despite its proven safety benefit, has not been readily accepted in clinical practice. Another option is to use systolic blood pressure plus a standard margin of error to obtain a safe cuff inflation pressure [10,85]. However the results of this estimation are suboptimal because of the variable relationship between LOP and systolic blood pressure [41,71].…”

Section: Limb Occlusion Pressurementioning

confidence: 99%

Tourniquet Use in Upper Limb Surgery

Oragui

Parsons

White

et al. 2010

Hand (New York, N,Y.)

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Tourniquets are compressive devices that occlude venous and arterial blood flow to limbs and are commonly used in upper limb surgery. With the potential risk of complications, there is some debate as to whether tourniquets should continue to be routinely used. In this review, we first look at the different designs, principles, and practical considerations associated with the use of tourniquets in the upper limb. The modern pneumatic tourniquet has many design features that enhance its safety profile. Current literature suggests that the risk of tourniquet-related complications can be significantly reduced by selecting cuff inflation pressures based on the limb occlusion pressure, and by a better understanding of the actual level of pressure within the soft tissue, and the effects of cuff width and contour. The evidence behind tourniquet time, placement, and limb exsanguination is also discussed as well as special considerations in patients with diabetes mellitus, hypertension, vascular calcification, sickle cell disease and obesity. We also provide an evidence-based review of the variety of local and systemic complications that may arise from the use of upper limb tourniquets including pain, leakage, and nerve, muscle, and skin injuries. The evidence in the literature suggests that upper limb tourniquets are beneficial in promoting optimum surgical conditions and modern tourniquet use is associated with a low rate of adverse events. With the improvement in knowledge and technology, the incidence of adverse events should continue to decrease. We recommend the use of tourniquets in upper limb surgery where no contraindications exist.

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Thigh pain following tourniquet application in simultaneous bilateral total knee replacement arthroplasty

Cited by 105 publications

References 21 publications

Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

The effect of tourniquet use in total knee arthroplasty

Tourniquet Use in Upper Limb Surgery

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