Do tourniquet and drainage influence fast track in total knee arthroplasty? Our results on 151 cases (original) (raw)
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The Ochsner journal, 2016
Blood loss during total knee arthroplasty (TKA) may require blood transfusions that are associated with increased risk, morbidity, and cost. Multiple techniques exist to reduce blood loss in TKA, including the use of a tourniquet and tranexamic acid (TXA). While multiple studies suggest that TXA is effective in reducing blood loss, the use of a tourniquet is more controversial. We studied the combined effect of TXA with a limited-use tourniquet on blood loss and complications in the setting of primary TKA. A retrospective review of a prospectively gathered arthroplasty database from a single institution was performed. We compared our limited-use cohort data with the published results of randomized controlled trials evaluating the effectiveness of tourniquets used during the entire TKA procedure. Fifty-one procedures from our institution's database met the inclusion criteria. TXA (administered in a single 15-mg/kg dose) with limited tourniquet use (a mean duration of 26.3 minutes...
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.
Effect of early release of tourniquet in total knee arthroplasty
Journal of the College of Physicians and Surgeons Pakistan Jcpsp, 2013
Objective: To evaluate whether tourniquet release intraoperatively is better than postoperative release in reducing overall blood loss, duration of surgery, duration of tourniquet, length of hospital stay, wound related complications and transfusion requirement. Study Design: Comparative study. Place and Duration of Study: Methodology: One hundred and thirty patient files were reviewed retrospectively. Patients were divided into two groups. Group-A consisted of 65 patients with early deflation of tourniquet and group-B comprised of 65 patients with the release of tourniquet after applying compressive dressing. Total blood loss (determined by Gross method) and other study variables were noted as per objective and computed. Results: There were 22 males and 108 females with comparable BMI. All had undergone posterior stabilized cemented total knee replacement. Calculated blood loss was 1.208 L and 1.108 L in group-A and B respectively (p = 0.27). Significant increase in duration of surgery was noted in group-A patients. Four patients in group-B showed complication related to wound with 3 being minor and 1 requiring additional operation room visit. Mean length of hospital stay was 9 days. Transfusion frequency was higher in group-B despite comparable postoperative haemoglobin values. Conclusion: Intraoperative tourniquet release does not reduce overall blood loss with no effect in conserving blood after total knee replacement, however, this group had relatively shorter hospital stay.
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
The Knee, 2003
The purpose of our study is to estimate the effect of tourniquet release and cementing in perioperative blood loss associated with total knee arthroplasty. Eighty patients were randomly allocated into two equal groups concerning the timing of tourniquet release. Group A: patients with tourniquet release and haemostasis before wound closure and group B: patients with tourniquet release after skin closure and compressive bandaging. These groups were further subdivided in two subgroups (q and y) depending on cementing or not of the tibial tray only. The total blood loss averaged 961 ml in group A and 692 ml in group B, while it was estimated 763 ml in the cemented group and 890 ml in the non-cemented group. The total blood loss within subgroups was Group Aq 904 ml, Group Ay 1017 ml, Group Bq 622 ml and Group By 762 ml. The mean number of blood units transfused per patient was 4.7 in Group A and 4.0 in Group B, while the mean operating time was 79 min and 66 min, respectively. Complications such as deep vein thrombosis, haematomata and minor wound complications occurred in patients of Group A and Group B, 0 and 2, 0 and 2, 8 and 11, respectively. Intraoperative tourniquet release seems to be related with significantly greater blood loss (P-0.001) and demands in blood transfusion P-0.05 as well as a longer operating time (P-0.001). Cementing of total knee replacements has a better haemostatic role compared to non-cemented prosthesis (P-0.05). Even though complications were more in postoperative tourniquet release group, no statistically significant difference was found between group A and B. Postoperative tourniquet release seems to offer better conditions of haemostasis probably due to the better controlled fibrolytic activity. ᮊ
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...
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.
International Journal of Orthopaedics Sciences
In our study, we compared the use of tranexamic acid (TXA) with tourniquet and Hemovac drain application in terms of bleeding, deep vein thrombosis (DVT), infection development and functional scores following total knee arthroplasty (TKA). Methods: Our TKA cases were evaluated retrospectively. The group that was not applied a tourniquet or Hemovac drain but administered TXA was designated as the study group (TXA group) and the group that was applied a tourniquet or Hemovac drain but was given no TXA was designated as the control group. The age, gender, operated side, body mass index, comorbid diseases, anesthesia type, duration of operation, perioperative blood pressure values of patients from both groups were recorded. Perioperative blood loss, the difference between preoperative and postoperative Hb and Hct values, need for transfusion, infection, DVT development and the WOMAC scores of both groups were compared. Results: The duration of surgery in the TXA group was 82.5±7.1 minutes and 75.2±4.2 minutes in the control group (p<0.05). Perioperative bleeding was higher in the TXA group (112.77±12.82 ml) than the control group (146.14±40.54 ml) (p<0.05). The difference between the preoperative and postoperative Hb levels was 2.9±0.7 g/dl in the control group compared to 1.5±0.5 g/dl in the TXA group. The need for transfusion, DVT and infection development in the postoperative period were significantly higher in the control group (p<0.05). In terms of functional scores, the only significant difference between the groups was detected in the WOMAC pain scores (p<0.05). Conclusion: A lower bleeding, transfusion, infection, DVT development rate and pain scores can be obtained with IV TXA application and without the use of a tourniquet or drain in TKA.
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...