Timing of Tourniquet Removal after Knee Replacement

Newman, JH; Jackson, J. P.; Waugh, W.

doi:10.1177/014107687907200706

Cited by 36 publications

(24 citation statements)

References 3 publications

(3 reference statements)

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“…After full texts were assessed for eligibility, 6 studies [11,27–31] were excluded because they were not RCTs, 2 studies were excluded because of different intervention. [32,33] After reviewing bibliographies of each study, 2 studies [12,25] were found. Finally, 16 RCTs [8,10,12–25] were included in our meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

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Timing of tourniquet release in total knee arthroplasty

Zhang

Liang

et al. 2017

Medicine

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Background:For total knee arthroplasty (TKA), the tourniquet is routinely employed for better visualization, less blood loss, and easier cementation. However, the time to release tourniquet remains controversial. Therefore, we performed current meta-analysis to assess whether releasing tourniquet before wound closure is more effective in reducing blood loss than releasing tourniquet after wound closure in TKA without an increased risk of complications.Methods:To conduct this meta-analysis, we searched Medline, Embase, Web of science, and the Cochrane library up to November 2016, for randomized controlled trials comparing tourniquet releasing before and after wound closure in TKA. A meta-analysis was performed following the guidelines of the Cochrane Reviewer's Handbook and the PRISMA statement. Methodological quality of the trials was assessed using the Cochrane risk assessment scale. The data of the included studies were analyzed using Stata 12.0.Results:Sixteen trials involving 1010 patients were identified in current meta-analysis. Our meta-analysis demonstrated that there were no significant differences in the 2 groups in terms of calculated blood loss (weighted mean difference [WMD] = 160.65, 95% confidence interval [CI]: −0.2 to 321.49, P = .05), postoperative blood loss (WMD = −45.41, 95% CI: −120.11 to 29.29, P = .233),postoperative hemoglobin decline (WMD = 0.16, 95% CI: −2.5 to 2.82, P = .905), transfusion volume (WMD = 79.19, 95% CI: −5.05 to 163.44, P = .065),transfusion rates (relative risk [RR] = 1.19, 95% CI: 0.95–1.50, P = .134), major complications (RR = 0.51, 95% CI: 0.15–1.73, P = .278), and deep vein thrombosis (RR = 0.44, 95% CI: 0.14–1.37, P = .157).Compared with the group of releasing tourniquet after wound closure, the group of releasing tourniquet before wound closure had a higher volume of total blood loss (WMD = 130.96, 95% CI: 58.83–203.09, P = .000) and a longer operation time (WMD = 6.56, 95% CI: 3.12–10.01, P = .000). However, releasing tourniquet before wound closure could reduce minor complications (RR = 0.53, 95% CI: 0.34–0.82, P = .004).Conclusions:On the basis of current meta-analysis, the method of releasing tourniquet before wound closure could increase total blood loss and operation time; nevertheless, the risk of complications decreased. Thus, if patients are in severe anemia condition, the tourniquet perhaps should be released after wound closure to decrease blood loss. In contrary, releasing tourniquet before wound closure to decrease the risk of complications would be a better choice.

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Section: Resultsmentioning

confidence: 99%

“…[32,33] After reviewing bibliographies of each study, 2 studies [12,25] were found. Finally, 16 RCTs [8,10,12–25] were included in our meta-analysis. The flow chart of study selection is shown in Figure 1 and the characteristics of each study are shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Timing of tourniquet release in total knee arthroplasty

Zhang

Liang

et al. 2017

Medicine

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“…Wound closure and apposing tissue layers with a firmly applied dressing can produce a local compressive effect and control this bleeding. Comparing different timings of the tourniquet release, significant differences in perioperative blood loss have been found [42][43][44][45][46][47][48][49][50]. A recent meta-analysis by Rama et al [36] found that intraoperative tourniquet release offered a better hemostatic control of major bleeding events that would otherwise have required a reoperation.…”

Section: Discussionmentioning

confidence: 99%

Comparative efficacy of different doses of fibrin sealant to reduce bleeding after total knee arthroplasty

Notarnicola¹,

Moretti²,

Martucci³

et al. 2012

Blood Coagulation &Amp; Fibrinolysis

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In recent years, the application of fibrin sealant has been shown to be efficacious in the management of intraoperative and postoperative hemostasis. We designed a prospective randomized controlled clinical trial to assess the efficacy of two different dosages of fibrin sealant (5 and 10 ml) in patients undergoing total knee arthroplasty, as compared with the untreated control group. A total of 90 patients entered the study, randomly assigned to one of the three groups: treatment with 5 ml fibrin sealant (30 patients), with 10 ml fibrin sealant (30 patients) or no treatment (30 patients). A statistically significant difference in the mean reduction of hemoglobin concentrations was found on the first postoperative day in the treated groups as compared with the controls: 5 ml fibrin sealant (2.6 mg/dl) and 10 ml fibrin sealant (2.5 mg/dl) vs. controls (3.7 mg/dl) (P = 0.024). The mean number of blood transfusions was significantly lower in the treated groups: 5 ml (0.5) and 10 ml (0.3) of fibrin sealant vs. controls (1) (P = 0.0019). Functional recovery was also better in the treated groups: on the seventh day, the joint ROM (range of motion) was statistically superior in the 5 ml group (96.5°) and 10 ml group (98.8°) as compared with the controls (75.5°) (P < 0.0001). This study supports the efficacy of administering fibrin sealant in the perioperative management of bleeding after total knee arthroplasty and shows that a 5 ml dosage yields a comparable outcome to the 10 ml dosage previously reported in the literature.

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“…In total knee replacement surgery, release of the tourniquet before closure of the wound has been recommended to control the divided geniculate branches of the popliteal artery, thereby reducing the blood loss postoperatively (Newman et al 1979, Page et al 1984. Only a few randomized studies have evaluated the efficacy of this procedure, and the results of these studies have been inconsistent.…”

Section: Discussionmentioning

confidence: 99%