Benefits of Limited Use of a Tourniquet Combined With Intravenous Tranexamic Acid During Total Knee Arthroplasty (original) (raw)
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Use of tranexamic acid may reduce the need for routine tourniquet use in total knee arthroplasty
Joint Diseases and Related Surgery
Perioperative blood loss during joint arthroplasties with excess bleeding may be a major concern for negative postoperative consequences including longer hospital stay and complicated rehabilitation in some cases. [1] Moreover, transfusion after massive blood loss in arthroplasties may result in an increased risk of infection, revision, and mortality. [2,3] To avoid these negative consequences, a tourniquet has been used conventionally for intraoperative bleeding control for a long time. [4] Decreased blood flow due to tourniquet use also provides a clear vision of anatomical structures in the operation site. [5] Nevertheless, postoperative hemorrhage is unlikely to be decreased in parallel to intraoperative bleeding after tourniquet use in total knee arthroplasty (TKA), but with some additional risks of complications. [6] Of note, there is a considerable debate about the safety of tourniquet Objectives: The aim of this study was to evaluate the effects of tranexamic acid (TXA) administration on bleeding control and to compare its utilization with and without simultaneous use of conventional pneumatic tourniquets during total knee arthroplasty (TKA). Patients and methods: Between January 2017 and December 2017, a total of 204 patients (23 males, 181 females; mean age: 66±6.9 years; range, 45 to 86 years) who underwent TKA for Stage 4 gonarthrosis were retrospectively analyzed. The patients were divided into two groups as those with (n=110) and without (n=94) pneumatic tourniquet use. Tranexamic acid (1 g) was administered intravenously to all patients in both study groups. Intra-and postoperative blood loss were calculated, and postoperative pain was evaluated by a Visual Analog Scale. Demographic and clinical data were compared between the study groups. Results: The amount of total blood loss and postoperative blood loss were significantly higher in the tourniquet group than that in the no-tourniquet group (589.4±69.5 mL vs. 490.8±55.2 mL and 326±56 mL vs. 164±35.5, respectively; p<0.001 for both). Intraoperative blood loss was significantly higher in the no-tourniquet group (326.9±42.9 mL vs. 263.5±53.8 mL, respectively; p<0.001). The pain score at 24 h was significantly higher in the tourniquet group (p<0.001). Conclusion: Total blood loss and postoperative pain were significantly higher among patients in whom a tourniquet was used during TKA. Therefore, the routine use of tourniquets with TXA should be reconsidered.
Blood loss in total knee arthroplasty with and without tourniquet
2019
Introduction: Total knee arthroplasty (TKA) is a commonly used surgical intervention utilized for patients suffering from arthritis. It is an efficacious surgical procedure which improves patient's quality of life, decreases the pain and elevates the functional capability of the patients [1].TKA is an important cause of blood loss during surgeries and many studies have shown a high rate of transfusions in these surgeries [2]. Transfusions themselves are associated with multiple complications, and are associated with an increased length of hospital stay, increased chances of infections and increase chances of contracting blood borne diseases with these blood transfusions. The use of tourniquet allows the orthopedic surgeon to have a blood-less operative field and also results in an improved cementation technique. However, the timing of tourniquet removal as the best option in preserving blood stock levels is a controversial topic, with varying point of views in literature. Newman...
International Journal of Research in Orthopaedics, 2018
Background: Primary total knee replacement (TKR) has traditionally been carried out with the use of a tourniquet. More recent trends towards performing the surgery without a tourniquet have had some support in the literature and may improve patient recovery. Methods: A retrospective cohort of 198 consecutive primary TKRs from our institution were identified and analysed, 52 used a tourniquet and 146 did not. All TKRs also utilised a standardised interventions protocol including withholding of anticoagulants and antiplatelet medications, topical adrenaline injection, and both IV and topical tranexamic acid. Outcomes measured were estimated intra-operative blood loss, overall blood loss through comparison of pre and post-operative haemoglobin laboratory values, and the need for post-operative blood transfusion. Results: Analysis demonstrated a statistically significant reduction in estimated intra-operative blood loss when a tourniquet was used (p<0.001). However, overall blood los...
Background: Until today, many studies conduct to determine the optimal dose and regimen of tranexamic acid to reduce the preoperative and postoperative blood loss in primary total knee arthroplasty. In this study, we were compared two different methods of administration (bolus and infusion). Materials and Methods: Forty patients were randomized in two groups; all the patients received 500 mg tranexamic acid before tourniquet was turned on. Group (A) consisted of 20 patients (mean age: 64± 6.1 years) received 500 mg tranexamic acid ten minutes before tourniquet was loosened and group (B) (63.5 ± 7.7 years) received 500 mg tranexamic acid IV infusion during 6 hours from the time of tourniquet loosening (total dose of TA 1 g in both groups). Intraoperative blood loss, postoperative drainage (in 6 and 12 hours), blood transfusion (in 48 hours), hematocrit and hemoglobin decrease (6 and 12 hours later) were compared between two groups. Results: The patients in group (B) had less blood lo...
2019
Backgruond To compare weight-based versus standard dosing of intravenous (IV) tranexamic acid for blood loss and transfusion amount in total knee arthroplasty (TNA) without tourniquet. Methods A total of 99 patients who underwent TNA with the diagnosis of primary osteoarthritis were enrolled in this retrospective case-control study. Patients were divided into two groups according to the application of tranexamic acid. Group 1 (weight-based dosing): 10 mg/kg IV TA 30 min before the skin incision, and 10 mg/kg, at postoperative 30 min, and 3 h. Group 2 (standard dosing): 1 g of IV TA 30 min before skin incision, and 1 g at postoperative 30 min and 3 h. Hemoglobin levels, before, and 1, and 2 days after the operation, postoperative amount of decrease in hemoglobin levels, and amount of erythrocyte transfusion were recorded. Two scoring systems Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Score (KSS) were applied in the evaluation of TNA result...
The timing of tourniquet release and its influence on blood loss after total knee arthroplasty
International Orthopaedics, 2004
We performed a prospective, randomized study on 76 patients (82 knees) scheduled for total knee arthroplasty to determine the effect of tourniquet release and hemostasis on the peri- and postoperative blood loss. Patients were randomly divided in two groups. Posterior cruciate retaining tricompartmental total knee prostheses were used in all. In group 1, the tourniquet was deflated intraoperatively after the prosthetic components were settled and hemostasis was done. In group 2, the tourniquet was released after the wound was closed and a compressive bandage was applied. Mean blood drainage was 880.85 ml (320–1,315) in group 1 and 745.36 ml (220–1,175) in group 2 (p=0.03). The mean number of blood transfusions given, hemoglobin and hematocrit values, operation time, and tourniquet time were similar in both groups. Intraoperative tourniquet release and hemostasis does not reduce total blood loss in total knee arthroplasty. Nous avons exécuté une étude prospective et randomisée sur 76 malades (82 genoux) programmé pour arthroplastie du genou total pour déterminer l’effet de la levée de garrot- hémostase sur le perte de sang per—et postopératoire. Une prothèse tricompartmentale du genou, avec conservation du croisé postérieur totale a été utilisée dans tous les cas. Les malades étaient randomisés et divisés en deux groupes. Dans le groupe 1 le garrot a été dégonflé en intraopératoire après que les composants prothétiques aient été posés et l’hémostase a, alors été faite. Dans le groupe 2 le garrot a été retiré après la fermeture et la mise en place d’un pansement compressif. La perte moyenne de sang par drainage était 880.85 ml (320–1315) dans le groupe 1 et 745.36 ml (220–1175) dans le groupe 2 (p=0.03). Le nombre moyen de transfusions du sang effectuées, les valeurs de l’hémoglobine et de l’hématocrite, la durée opératoire et la durée du garrot étaient semblables dans les deux groupes.La levée du garrot pendant l’opération avec hémostase ne réduit pas la perte totale du sang dans l’arthroplastie du genou.
HSS Journal, 2013
Background: Many studies have investigated the effect of tourniquet release time and closed suction drainage in total knee arthroplasty (TKA). However, controversy remains as to the advisability of preclosure tourniquet release and the advisability of closed suction drain use following total knee arthroplasty. Questions/Purposes: The aim of the study was to investigate if there is a benefit of performing tourniquet release after skin closure, along with drain clamping, for the first 6h following TKA. Methods: Ninety-six patients underwent TKA between May 2009 and April 2010. Fourteen of these were excluded because of systemic diseases and simultaneous bilateral TKA. Twenty-nine of these were excluded due to use of a patellar component and posterior cruciate ligament (PCL)-sacrificing systems. Thus, 53 patients that underwent PCL-retaining cemented TKA were reviewed retrospectively. In the control group (group C), the tourniquet was released before skin closure, an attempt at hemostasis was made, and a compressive bandage was applied. The drain was not clamped in these patients. The test group of 23 patients (group T) had tourniquet release after skin closure and after the compressive bandage was applied. The drain was clamped for the first 6h after surgery. The two groups were compared as to the amount of drained blood, postoperative change in hemoglobin, postoperative complications, and knee function. Results: We found that drained blood and hemoglobin drop were significantly lower in group T compared with group C. There was no difference regarding postoperative complications and knee function. Conclusion: We conclude that tourniquet release after skin closure and compressive dressing followed by 6h of drain clamping reduces postoperative blood loss in TKR surgery. Keywords total knee arthroplasty. blood lost. tourniquet release time. drain clamping and compressive bandage
2018
B ackground : So far , many studies have been performed to determine the optimal dose and regimen of tranexamic acid to reduce preoperative and postoperative blood loss in primary total knee arthroplasty. In th e present study, two different methods of administration (bolus and infusion) , were compared. Materials and Methods : Forty patients were randomized in the two groups (A and B) of 20 patient s each . A ll patients received 500 mg tranexamic acid before inflation of tourniquet. Group A (mean age , 64± 6.1 years) received 500 mg tranexamic acid 10 minutes before loosening of tourniquet and group B ( mean age, 63.5 ± 7.7 years) received 500 mg tranexamic acid through IV infusion during 6 hours from the time of tourniquet loosening (total dose of TA , 1 g in both groups). Intraoperative blood loss, postoperative drainage (in 6 and 12 hours), blood transfusion (in 48 hours), and decrease in hematocrit and hemoglobin (6 and 12 hours later) , were compared ...