Tourniquet use in patients undergoing tumour resection and endoprosthetic reconstruction of the knee

Abstract

Aims The aim of this study was to determine the prevalence and impact of tourniquet use in patients undergoing limb salvage surgery with endoprosthetic reconstruction for a tumour around the knee. Methods We retrieved data from the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial; specifically, differences in baseline characteristics, surgical details, and postoperative functional outcomes between patients who had undergone surgery under tourniquet and those who had not. A linear regression model was created to evaluate the impact of tourniquet use on postoperative Toronto Extremity Salvage Scores (TESSs) while controlling for confounding variables. A negative-binomial regression model was constructed to explore predictors of postoperative length of stay (LOS). Results Of the 604 patients enrolled in the PARITY trial, 421 had tumours around the knee joint, of whom 225 (53%) underwent surgery under tourniquet. The tourniquet group was younger (p = 0.014), more likely to undergo surgery for a tumour of the tibia, and had shorter operating times by a mean of 50 minutes (95% confidence interval 30 to 72; p < 0.001). The adjusted linear regression model found that the use of a tourniquet, a shorter operating time, and a higher baseline TESS independently predicted better function at both three- and six-month follow-up. The negative-binomial regression model showed that tourniquet use, shorter operating time, younger age, and intraoperative tranexamic acid administration independently predicted a shorter LOS in hospital. Conclusion The results of this study show that in patients undergoing resection of a tumour around the knee and endoprosthetic reconstruction, the use of an intraoperative tourniquet is associated with a shorter operating time, a reduced length of stay in hospital, and a better early functional outcome. Cite this article: Bone Joint J 2022;104-B(10):1168–1173.

What’s New in Musculoskeletal Tumor Surgery

“…However, the group with greater trochanter preservation had lower dislocation rates. Gazendam et al reviewed patients undergoing a limb-salvage surgical procedure and endoprosthetic reconstruction around the knee and evaluated the utility of intraoperative tourniquet use 7 . They demonstrated that the use of an intraoperative tourniquet was associated with better early functional outcome, as well as a shorter operative time and a reduced length of hospital stay.…”

“…The Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) Randomized Controlled Trial Secondary Analysis Supplement The PARITY trial was published online in January 2022, and the data set was opened to all investigators to perform secondary analyses 70 . A total of 13 PARITY secondary analyses were recently published in a JBJS Supplement [71][72][73][74][75][76][77][78][79][80][81][82][83] . These important studies address several exploratory questions, including, among others, the risk factors for surgical site infection and reoperations following lower-extremity endo-prosthetic reconstruction, functional outcomes in pediatric patients compared with adult patients, the use of opioids in the orthopaedic oncology population, the use of negative-pressure wound therapy and postoperative drains and the risk for surgical site infection, the risk of thromboembolism following lower-extremity endoprosthetic reconstruction, and biopsy types and their effect on surgical variables and outcomes.…”