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

Ahmed, Imran; Chawla, Amit; Underwood, Martin; Price, Andrew; Metcalfe, Andrew; Hutchinson, Charles E.; Warwick, Jane; Seers, Kate; Parsons, Helen; Wall, Peter

doi:10.1302/0301-620x.103b.bjj-2020-1926.r1

Cited by 46 publications

(74 citation statements)

References 54 publications

(72 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, Huang et al reported that short-term tourniquet use was not favorable for achieving early functional results [ 25 ], and Kvederas et al reported the highest estimated bleeding volume in limited use of a tourniquet only during cement fixation compared with the other longer-use strategies [ 26 ]. A systematic review and meta-analysis was recently published that discussed these differences and controversies among many studies regarding the differences in tourniquet use [ 6 ]. They concluded that the lack of a tourniquet did not increase total blood loss and perioperative complications.…”

Section: Discussionmentioning

confidence: 99%

“…TKA performed without a tourniquet tends to bleed and leads to difficulty in securing the intraoperative field of view [ 5 ]. Many studies have examined the risks and benefits of tourniquet use in TKA, and a recent systematic review with meta-analysis revealed that TKA performed with a tourniquet had a higher risk of venous thromboembolic (VTE) events, greater postoperative pain, and longer hospital stays but no difference in overall blood loss compared with TKA performed without a tourniquet [ 6 ]. However, few studies have determined the benefit and safety of TKA performed without a tourniquet in patients who are older, such as those aged > 70 years.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Safety of Total Knee Arthroplasty without Using a Tourniquet in Elderly Patients

Miyamoto¹,

Kosugi²,

Sasaki³

et al. 2021

Geriatrics

View full text Add to dashboard Cite

This study retrospectively compared the perioperative bleeding, hemodynamics, and clinical outcomes of total knee arthroplasty (TKA) performed with and without a tourniquet between two age groups. We grouped 103 patients with knee osteoarthritis who underwent primary TKA based on age at surgery: <76 years and ≥76 years. Tourniquet was used for TKA until March 2010 and stopped thereafter; hence, the patients were further classified according to TKA performed with or without a tourniquet. The differences in the operation time; perioperative bleeding; estimated bleeding; and hemoglobin (Hb) and hematocrit (Ht) levels immediately, 1 day, and 7 days postoperatively were evaluated. The clinical outcomes for range of motion, and Knee Society Knee Scores preoperatively and at 4 weeks postoperatively were assessed. Operation time was longer in the ≥76-year-old non-tourniquet group. No difference was observed in estimated bleeding among the groups. Changes in the Hb and Ht levels at postoperative days 1 and 7 were negatively correlated with age but were not different for TKA performed with or without a tourniquet in the ≥76-year-old-patient group. There were no differences in clinical outcomes among the groups. TKA can be performed with or without a tourniquet in patients aged ≥ 76 years with careful assessment of postoperative anemia.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Safety of Total Knee Arthroplasty without Using a Tourniquet in Elderly Patients

Miyamoto¹,

Kosugi²,

Sasaki³

et al. 2021

Geriatrics

View full text Add to dashboard Cite

show abstract

“…Additionally, it has the advantage of reducing the amount of bleeding [ 3 ] during and after surgery, and shortening operation times [ 4 ]. However, it can sometimes cause damage to nerves [ 5 ], blood vessels, and muscles, causing swelling or restrictions to the postoperative range of motion [ 6 , 7 ]. Several studies have demonstrated that pain and swelling after surgery can be reduced by reducing the tourniquet application time or lowering the tourniquet pressure [ 8 ], but this is still a controversial topic [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…As the duration of uninterrupted tourniquet inflation increased the likelihood of neural dysfunction [ 15 ], it was expected that this method would reduce the amount of bleeding by applying the tourniquet until the end of skin closure, but would not increase the complications due to the 15 min resting period. In previous studies, the outcomes have been compared with a lack of tourniquet use [ 6 ], loosening the tourniquet after cement injection, or even after the skin incision [ 16 , 17 ]. However, to the best of our knowledge, no published studies have investigated the risks and benefits associated with tourniquet reapplication after an intra-operative rest period.…”

Section: Introductionmentioning

confidence: 99%

The Association between Two-Stage Tourniquet Application during Total Knee Replacement and Blood Loss: A Retrospective Cohort Study

Kim

et al. 2022

JCM

View full text Add to dashboard Cite

Tourniquet use during total knee arthroplasty improves the surgical field, but is associated with several complications. The medical records of 506 patients who underwent elective total knee arthroplasty or total knee replacement from January 2017 to December 2020 were reviewed. A total of 331 patients who had undergone total knee arthroplasty were included. In the first half course group, the tourniquet was inflated with a pressure of 300 mmHg after manual banding before the incision and deflated after cement insertion. In the two-stage group, the tourniquet was inflated and deflated at the same stages of the procedure as in the first half course group. However, in this second group, the tourniquet was deflated for 15 min and then inflated again, and, finally, it was deflated after skin closure. The estimated blood loss, the number of patients who needed medications to control their blood pressure, and opioid usage at the post-anesthesia care unit were similar in both groups. The two-stage tourniquet technique was not related to reduced total blood loss in total knee arthroplasty.

show abstract

“…Total knee arthroplasty (TKA) is an effective and well-established procedure for the treatment of advanced KOA. However, it can cause postoperative bleeding and even severe anemia for surgical trauma and fibrinolysis [ 3 , 4 ]. The common methods for reducing perioperative bleeding are the application of tranexamic acid (TXA), tourniquet, and postoperative compression.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Blood Loss Can Be Reduced If Total Knee Arthroplasty Was Performed in the Si Hour-Period, Compared with the Wei Hour-Period: A Retrospective Cohort Study

Wang

et al. 2021

Evidence-Based Complementary and Alternative Medicine

View full text Add to dashboard Cite

Objective. To investigate the efficacy and safety of performing primary unilateral total knee arthroplasty (TKA) in the “Si hour-period” meaning 09:00 a.m. to 11:00 a.m. (one of the 12 two-hour periods into which the day was traditionally divided, each being given the name of one of the 12 earthly branches), compared with the “Wei hour-period” (13:00–15:00). Methods. Patient documentations were studied for those who underwent a primary unilateral TKA performed by the same surgical team with a tourniquet between January 2018 and January 2021 at our medical center. Eighty-four patients were enrolled and assigned into group A (in Si hour-period) and group B (in Wei hour-period). The main outcomes were total blood cell loss (TBL), hidden blood loss (HBL), visible blood loss (VBL), maximum hemoglobin (Hb) drop, and transfusion rate. Secondary outcomes were length of hospital stay (LOS), postoperative femorotibial mechanical axis (FTMA), FTMA correction, platelet count, plasma D-dimer (D-D), prothrombin time (PT), international normalized ratio (INR), and the incidence of postoperative complications. Results. Group A showed statistical significance lower at the mean TBL, the mean HBL, and the maximum Hb drop (95% CI: −352.8 to −46.1, P = 0.011 , 95% CI: −348.0 to −40.1, P = 0.014 , and 95% CI: −9.5 to −0.7, P = 0.023 , respectively) after TKA than group B. The postoperative platelet count of group A was more significant than that of group B (95% CI:3.1 to 52.9, P = 0.028 ). The VBL, transfusion rate, the LOS, postoperative FTMA, FTMA correction, plasma D-D, PT, INR, and the incidence of postoperative complications (wound complications, calf muscular vein thrombosis, infection, pulmonary embolism, and deep vein thrombosis) were similar between the two groups ( P > 0.05 , respectively). Conclusion. Our study shows that blood loss can be reduced when TKA is performed in the “Si hour-period,” which may be due to increasing platelet count, and postoperative complications did not increase, compared with the Wei hour-period. We recommend that the selective operation, such as TKA, should be performed in the “Si hour-period” in clinical practice between the two hour-period.

show abstract

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

Cited by 46 publications

References 54 publications

Safety of Total Knee Arthroplasty without Using a Tourniquet in Elderly Patients

Safety of Total Knee Arthroplasty without Using a Tourniquet in Elderly Patients

The Association between Two-Stage Tourniquet Application during Total Knee Replacement and Blood Loss: A Retrospective Cohort Study

Perioperative Blood Loss Can Be Reduced If Total Knee Arthroplasty Was Performed in the Si Hour-Period, Compared with the Wei Hour-Period: A Retrospective Cohort Study

Contact Info

Product

Resources

About