Tourniquet and tranexamic acid use in total knee arthroplasty

Abstract

Background: There is no consensus on how tourniquet and tranexamic acid (TXA) use in total knee arthroplasty (TKA) affect blood transfusion rates and total blood loss. We compared outcome measures and transfusion rates after TKA, with and without the use of tourniquet and TXA. Methods: A retrospective study of 477 consecutive patients undergoing primary TKA between 2008 and 2013 was performed. There were 243 in the tourniquet-assisted (TA) and 234 in the tourniquetunassisted (TU) group. Operative times, hemoglobin levels, blood transfusion rates, complications, and length of stay were assessed. Subanalysis was performed on those patients receiving and not receiving TXA within the TU group. Results: Mean operative duration was 66.4 minutes in the TA group and 87.5 minutes in the TU group (P < .0001). Mean postoperative drop in hemoglobin was greater in TU group (3.1 g/dL vs 2.8 g/dL, P ¼ .002). The transfusion rate was 9.5% in TA compared with 11.5% in TU patients (P ¼ .46) with comparable mean units transfused (2.6 vs 2.2, P ¼ .30). There was no difference in wound infection (P ¼ .82) and total complication rates (P ¼ .27) between groups. Those patients given TXA had a lower hemoglobin drop (2.6 g/ dL vs 3.3 g/dL, P ¼ .04) with similar transfusion (13.3% vs 11%, P ¼ .61) and complication (P ¼ .95) rates. Conclusions: TU TKA had a greater operative duration and postoperative drop in hemoglobin than TA TKA. However, transfusion rates were similar between groups. TXA use reduced the operative decrease in hemoglobin with no effect on complication or transfusion rates.

Effect of tourniquet use on blood loss, pain, functional recovery, and complications in robot-assisted total knee arthroplasty: a prospective, double-blinded, randomized controlled trial

“…Numerous studies have shown that using a tourniquet during conventional TKA does not reduce total blood loss, but instead it appears to increase risk of more severe pain, longer length of stay, slower functional recovery, and complications [ 21 , 26 , 30 – 32 ], similar to our results. Since robot-assisted TKA takes significantly longer than conventional surgery [ 33 ], and since risk of tourniquet-associated complications increases with tourniquet time [ 34 ], we suspect that at least some of the adverse effects of tourniquet use in robot-assisted TKA relate to the relatively long operation time.…”

Effect of Tourniquet use on Blood Loss, Pain, Functional Recovery, and Complications in Robot-assisted Total Knee Arthroplasty: A Prospective, Double-blinded, Randomized Controlled Trial

“…Numerous studies have shown that using a tourniquet during conventional TKA does not reduce total blood loss, but instead it appears to increase risk of more severe pain, longer length of stay, slower functional recovery, and complications [21,25,[28][29][30] , similar to our results. Since robot-assisted TKA takes signi cantly longer than conventional surgery [31] , and since risk of tourniquet-associated complications increase with tourniquet time [32] , we suspect that at least some of the adverse effects of tourniquet use in robot-assisted TKA relate to the relatively long operation time.…”

Impact of tourniquet during knee arthroplasty: a bayesian network meta-analysis of peri-operative outcomes

“…The use of tranexamic acid and the avoidance of drainages has been supposed to eradicate the use of tourniquet. However, this is still controversial [ 91 , 92 ]. The effects of different tourniquet applications on cement penetration and implant anchorage were not evaluated, nor were type of prosthesis, technique, surgical approach, or length of skin incision.…”