EFFECTS OF TOURNIQUET USE ON PERIOPERATIVE OUTCOME IN TOTAL KNEE ARTHROPLASTY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANGQi ,  DONGJiyuan , GONGKe , LIXiang , ZHENGShihao , WENTao

Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P. R. China;

Corresponding author：

DONGJiyuan, Email: dongjiyuan81301@163.com

Keywords：

Total knee arthroplasty; Tourniquet; Early rehabilitation; Blood loss; Thrombosis

DOI：

10.7507/1002-1892.20160085

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To clarify the effects of tourniquet use on pain, early rehabilitation, blood loss, incidence rate of thrombosis in primary total knee arthroplasty (TKA) through a randomized controlled trial. Method Between Janurary 2014 and August 2015, 168 patients with knee osteoarthritis undergoing primary TKA were randomly allocated to tourniquet group (n=84) or non-tourniquet group (n=82) . There was no significant difference in gender, age, body mass index, affected side, osteoarthritis grading, disease duration, preoperative range of motion (ROM), visual analogue scale (VAS), Hospital for Special Surgery (HSS) score, and hemoglobin (Hb) between 2 groups (P>0.05) . The operation time, hospitalization time, 90°knee flexion time, straight leg lifting time, and ambulation time were compared between 2 groups. Intraoperative blood loss, Hb decrease, postoperative VAS score, HSS score, ROM, and postoperative complications were recorded and compared. Results There was no significant difference in operation time (t=-1.353, P=0.178) . The patients were followed up 3-20 months (mean, 12 months) in tourniquet group, and 3-22 months (mean, 13 months) in non-tourniquet group. No significant difference was found in Hb decrease (t=-1.855, P=0.066) and transfusion rate (23.81% of tourniquest group vs. 25.61% of non-tourniquest group) (χ²=0.072, P=0.788) between 2 groups. Significant difference was found in the incidence rate of thrombosis between tourniquet and non-tourniquet groups (10.71% vs. 2.44%) (χ²=4.592, P=0.032) , and the intraoperative blood loss of tourniquet group was significantly less than that of non-tourniquet group (t=-16.066, P=0.000) . The 90°knee flexion time, straight leg lifting time, ambulation time, and hospitalization time of tourniquet group were significantly later than those of non-tourniquet group (P<0.05) . The tourniquet group had significantly higher VAS score at 3, 5, 7, and 14 days after operation (P<0.05) and lower HSS score at 28 days after operation (t=-4.192, P=0.000) than non-tourniquet group, but there was no significant difference in the ROM between 2 groups (t=0.676, P=0.500) . Conclusions The use of a tourniquet during TKA will increase knee pain and thrombotic events, but can not decrease total blood loss and transfusion rate. A tourniquet use during TKA is unfavorable for early rehabilitation progress.

Citation： ZHANGQi, DONGJiyuan, GONGKe, LIXiang, ZHENGShihao, WENTao. EFFECTS OF TOURNIQUET USE ON PERIOPERATIVE OUTCOME IN TOTAL KNEE ARTHROPLASTY. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(4): 421-425. doi: 10.7507/1002-1892.20160085 Copy

1.	Carr AJ, Robertsson O, Graves S, et al. Knee replacement. Lancet, 2012, 379(9823) :1331-1340.
2.	Waimann CA, Fernandez-Mazarambroz RJ, Cantor SB, et al. Cost-effectiveness of total knee replacement:a prospective cohort study. Arthritis Care Res (Hoboken), 2014, 66(4) :592-599.
3.	Tai TW, Chang CW, Lai KA, et al. Effects of tourniquet use on blood loss and soft-tissue damage in total knee arthroplasty:a randomized controlled trial. J Bone Joint Surg (Am), 2012, 94(24) :2209-2215.
4.	Parvizi J, Diaz-Ledezma C. Total knee replacement with the use of a tourniquet:more pros than cons. Bone Joint J, 2013, 95-B(11 Suppl A):133-134.
5.	Harsten A, Bandholm T, Kehlet H, et al. Tourniquet versus no tourniquet on knee-extension strength early after fast-track total knee arthroplasty; a randomized controlled trial. Knee, 2015, 22(2) :126-130.
6.	Zhang W, Li N, Chen S, et al. The effects of a tourniquet used in total knee arthroplasty:a meta-analysis. J Orthop Surg Res, 2014, 9(1) :13.
7.	Olivecrona C, Ponzer S, Hamberg P, et al. Lower tourniquet cuff pressure reduces postoperative wound complications after total knee arthroplasty:a randomized controlled study of 164 patients. J Bone Joint Surg (Am), 2012, 94(24) :2216-2221.
8.	Morze CJ, Johnson NR, Williams G, et al. Knee pain during the first three months after unilateral total knee arthroplasty:a multi-centre prospective cohort study. J Arthroplasty, 2013, 28(9) :1565-1570.
9.	Appell HJ, Glöser S, Duarte JA, et al. Skeletal muscle damage during tourniquet-induced ischaemia. The initial step towards atrophy after orthopaedic surgery? Eur J Appl Physiol Occup Physiol, 1993, 67(4) :342-347.
10.	Ledin H, Aspenberg P, Good L. Tourniquet use in total knee replacement does not improve fixation, but appears to reduce final range of motion. Acta Orthop, 2012, 83(5) :499-503.
11.	Fan Y, Jin J, Sun Z, et al. The limited use of a tourniquet during total knee arthroplasty:a randomized controlled trial. Knee, 2014, 21(6:1263-1268.
12.	Holm B, Kristensen MT, Bencke J, et al. Loss of knee-extension strength is related to knee swelling after total knee arthroplasty. Arch Phys Med Rehabil, 2010, 91(11) :1770-1776.
13.	Liu D, Graham D, Gillies K, et al. Effects of tourniquet use on quadriceps function and pain in total knee arthroplasty. Knee Surg Relat Res, 2014, 26(4) :207-213.
14.	Silver R, de la Garza J, Rang M, et al. Limb swelling after release of a tourniquet. Clin Orthop Relat Res, 1986, (206) :86-89.
15.	Aglietti P, Baldini A, Vena LM, et al. Effect of tourniquet use on activation of coagulation in total knee replacement. Clin Orthop Relat Res, 2000, (371) :169-177.
16.	Blanié A, Bellamy L, Rhayem Y, et al. Duration of postoperative fibrinolysis after total hip or knee replacement:a laboratory follow-up study. Thromb Res, 2013, 131(1) :e6-e11.
17.	Parmet JL, Horrow JC, Berman AT, et al. The incidence of large venous emboli during total knee arthroplasty without pneumatic tourniquet use. Anesth Analg, 1998, 87(2) :439-444.
18.	Fukuda A, Hasegawa M, Kato K, et al. Effect of tourniquet application on deep vein thrombosis after total knee arthroplasty. Arch Orthop Trauma Surg, 2007, 127(8) :671-675.
19.	Katsumata S, Nagashima M, Kato K, et al. Changes in coagulation-fibrinolysis marker and neutrophil elastase following the use of tourniquet during total knee arthroplasty and the influence of neutrophil elastase on thromboembolism. Acta Anaesthesiol Scand, 2005, 49(4) :510-516.
20.	Watanabe H, Kikkawa I, Madoiwa S, et al. Changes in blood coagulation-fibrinolysis markers by pneumatic tourniquet during total knee joint arthroplasty with venous thromboembolism. J Arthroplasty, 2014, 29(3) :569-573.

1. Carr AJ, Robertsson O, Graves S, et al. Knee replacement. Lancet, 2012, 379(9823) :1331-1340.
2. Waimann CA, Fernandez-Mazarambroz RJ, Cantor SB, et al. Cost-effectiveness of total knee replacement:a prospective cohort study. Arthritis Care Res (Hoboken), 2014, 66(4) :592-599.
3. Tai TW, Chang CW, Lai KA, et al. Effects of tourniquet use on blood loss and soft-tissue damage in total knee arthroplasty:a randomized controlled trial. J Bone Joint Surg (Am), 2012, 94(24) :2209-2215.
4. Parvizi J, Diaz-Ledezma C. Total knee replacement with the use of a tourniquet:more pros than cons. Bone Joint J, 2013, 95-B(11 Suppl A):133-134.
5. Harsten A, Bandholm T, Kehlet H, et al. Tourniquet versus no tourniquet on knee-extension strength early after fast-track total knee arthroplasty; a randomized controlled trial. Knee, 2015, 22(2) :126-130.
6. Zhang W, Li N, Chen S, et al. The effects of a tourniquet used in total knee arthroplasty:a meta-analysis. J Orthop Surg Res, 2014, 9(1) :13.
7. Olivecrona C, Ponzer S, Hamberg P, et al. Lower tourniquet cuff pressure reduces postoperative wound complications after total knee arthroplasty:a randomized controlled study of 164 patients. J Bone Joint Surg (Am), 2012, 94(24) :2216-2221.
8. Morze CJ, Johnson NR, Williams G, et al. Knee pain during the first three months after unilateral total knee arthroplasty:a multi-centre prospective cohort study. J Arthroplasty, 2013, 28(9) :1565-1570.
9. Appell HJ, Glöser S, Duarte JA, et al. Skeletal muscle damage during tourniquet-induced ischaemia. The initial step towards atrophy after orthopaedic surgery? Eur J Appl Physiol Occup Physiol, 1993, 67(4) :342-347.
10. Ledin H, Aspenberg P, Good L. Tourniquet use in total knee replacement does not improve fixation, but appears to reduce final range of motion. Acta Orthop, 2012, 83(5) :499-503.
11. Fan Y, Jin J, Sun Z, et al. The limited use of a tourniquet during total knee arthroplasty:a randomized controlled trial. Knee, 2014, 21(6:1263-1268.
12. Holm B, Kristensen MT, Bencke J, et al. Loss of knee-extension strength is related to knee swelling after total knee arthroplasty. Arch Phys Med Rehabil, 2010, 91(11) :1770-1776.
13. Liu D, Graham D, Gillies K, et al. Effects of tourniquet use on quadriceps function and pain in total knee arthroplasty. Knee Surg Relat Res, 2014, 26(4) :207-213.
14. Silver R, de la Garza J, Rang M, et al. Limb swelling after release of a tourniquet. Clin Orthop Relat Res, 1986, (206) :86-89.
15. Aglietti P, Baldini A, Vena LM, et al. Effect of tourniquet use on activation of coagulation in total knee replacement. Clin Orthop Relat Res, 2000, (371) :169-177.
16. Blanié A, Bellamy L, Rhayem Y, et al. Duration of postoperative fibrinolysis after total hip or knee replacement:a laboratory follow-up study. Thromb Res, 2013, 131(1) :e6-e11.
17. Parmet JL, Horrow JC, Berman AT, et al. The incidence of large venous emboli during total knee arthroplasty without pneumatic tourniquet use. Anesth Analg, 1998, 87(2) :439-444.
18. Fukuda A, Hasegawa M, Kato K, et al. Effect of tourniquet application on deep vein thrombosis after total knee arthroplasty. Arch Orthop Trauma Surg, 2007, 127(8) :671-675.
19. Katsumata S, Nagashima M, Kato K, et al. Changes in coagulation-fibrinolysis marker and neutrophil elastase following the use of tourniquet during total knee arthroplasty and the influence of neutrophil elastase on thromboembolism. Acta Anaesthesiol Scand, 2005, 49(4) :510-516.
20. Watanabe H, Kikkawa I, Madoiwa S, et al. Changes in blood coagulation-fibrinolysis markers by pneumatic tourniquet during total knee joint arthroplasty with venous thromboembolism. J Arthroplasty, 2014, 29(3) :569-573.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTS OF TOURNIQUET USE ON PERIOPERATIVE OUTCOME IN TOTAL KNEE ARTHROPLASTY

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content