Effect of pneumatic tourniquet on perioperative blood loss in total knee arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Ziqi , LIANG Jialin , ZUO Xiaoli , LIU Ruiyu , DANG Xiaoqian ,  WANG Kunzheng

First Department of Orthopedics, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Shaanxi, 710004, P.R.China;

Corresponding author：

WANG Kunzheng, Email: xjtuwkz@163.com

Keywords：

Pneumatic tourniquet; total knee arthroplasty; osteoarthritis; total blood loss; hidden blood loss

DOI：

10.7507/1002-1892.201902025

Video：

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Objective To evaluate the effect of pneumatic tourniquet on perioperative period of total knee arthroplasty (TKA). Methods The perioperative period data of 116 patients over 60 years old with severe knee osteoarthritis treated with TKA between January 2018 and January 2019 were retrospectively analyzed. According to whether pneumatic tourniquet was used during operation, the patients were divided into trial group (49 cases, pneumatic tourniquet was not used during operation) and control group (67 cases, pneumatic tourniquet was used during operation). There was no significant difference in gender, age, body mass index, lesion side, disease duration, and preoperative hemoglobin between the two groups (P>0.05). The operation time, actual total blood loss, overt blood loss, hidden blood loss, and percentage of hidden blood loss, knee swelling at 3 days after operation, and range of motion of knee at 2 weeks after operation were recorded and compared between the two groups. Results The operation time of the trial group was significantly longer than that of the control group (t=14.013, P=0.000). The actual total blood loss, hidden blood loss, and percentage of hidden blood loss in the trial group were significantly lower than those in the control group (P<0.05); there was no significant difference in the overt blood loss between the two groups (t=−1.293, P=0.200). The knee swelling degree in the trial group was significantly slighter than that in the control group at 3 days after operation, and the range of motion of knee in the trial group was significantly better than that in the control group at 2 weeks after operation (P<0.05). Conclusion Pneumatic tourniquet can reduce the operation time of TKA significantly. However, it may increase the hidden blood loss and knee swelling, and negatively impact the recovery of knee function in the early postoperative stage of TKA.

Citation： ZHANG Ziqi, LIANG Jialin, ZUO Xiaoli, LIU Ruiyu, DANG Xiaoqian, WANG Kunzheng. Effect of pneumatic tourniquet on perioperative blood loss in total knee arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(6): 681-684. doi: 10.7507/1002-1892.201902025 Copy

1.	Shi M, Zhang J, Zhang Y, et al. Effect of a 12-hour natural drainage technique on decreasing blood loss after total knee arthroplasty: a case-control study. Ther Clin Risk Manag, 2018, 14: 1169-1174.
2.	Gao FQ, Li ZJ, Zhang K, et al. Four methods for calculating blood-loss after total knee arthroplasty. Chin Med J (Engl), 2015, 128(21): 2856-2860.
3.	Lohmann-Jensen R, Holsgaard-Larsen A, Emmeluth C, et al. The efficacy of tourniquet assisted total knee arthroplasty on patient-reported and performance-based physical function: a randomized controlled trial protocol. BMC Musculoskelet Disord, 2014, 15: 110.
4.	Mayer C, Franz A, Harmsen JF, et al. Soft-tissue damage during total knee arthroplasty: Focus on tourniquet-induced metabolic and ionic muscle impairment. J Orthop, 2017, 14(3): 347-353.
5.	Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology, 1983, 58(3): 277-280.
6.	Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery, 1962, 51(2): 224-232.
7.	Brock TM, Sprowson AP, Muller S, et al. STICKS study-Short-s Tretch Inelastic Compression bandage in Knee Swelling following total knee arthroplasty—a feasibility study. Trials, 2017, 18(1): 6.
8.	徐浩, 王昌耀, 张海宁, 等. 活动平台与固定平台假体行人工全膝关节置换术十年疗效的比较研究. 中国修复重建外科杂志, 2017, 31(3): 271-277.
9.	Lindner M, Nosseir O, Keller-Pliessnig A, et al. Psychosocial predictors for outcome after total joint arthroplasty: a prospective comparison of hip and knee arthroplasty. BMC Musculoskelet Disord, 2018, 19(1): 159.
10.	刘德健, 李彦林, 蔡国锋, 等. 3D打印截骨导板辅助人工全膝关节置换术早期疗效分析. 中国修复重建外科杂志, 2018, 32(7): 899-905.
11.	Hu Y, Li Q, Wei BG, et al. Blood loss of total knee arthroplasty in osteoarthritis: an analysis of influential factors. J Orthop Surg Res, 2018, 13(1): 325.
12.	Bonanzinga T, Tanzi P, Pia Neri M, et al. Evaluation of blood loss and implant alignment after total knee arthroplasty with inertial based extramedullary femoral cutting guide. Joints, 2018, 6(3): 161-166.
13.	Dennis DA, Kittelson AJ, Yang CC, et al. Does tourniquet use in TKA affect recovery of lower extremity strength and function? A randomized trial. Clin Orthop Relat Res, 2016, 474(1): 69-77.
14.	Dreyer HC. Tourniquet use during knee replacement surgery may contribute to muscle atrophy in older adults. Exerc Sport Sci Rev, 2016, 44(2): 61-70.
15.	Ozkunt O, Sariyilmaz K, Gemalmaz HC, et al. The effect of tourniquet usage on cement penetration in total knee arthroplasty: A prospective randomized study of 3 methods. Medicine (Baltimore), 2018, 97(4): e9668.
16.	Vaishya R, Agarwal AK, Vijay V, et al. Short term outcomes of long duration versus short duration tourniquet in primary total knee arthroplasty: A randomized controlled trial. J Clin Orthop Trauma, 2018, 9(1): 46-50.
17.	Leurcharusmee P, Sawaddiruk P, Punjasawadwong Y, et al. The possible pathophysiological outcomes and mechanisms of tourniquet-induced ischemia-reperfusion injury during total knee arthroplasty. Oxid Med Cell Longev, 2018, 2018: 8087598.
18.	Wang C, Zhou C, Qu H, et al. Comparison of tourniquet application only during cementation and long-duration tourniquet application in total knee arthroplasty: a meta-analysis. J Orthop Surg Res, 2018, 13(1): 216.
19.	Vivacqua T, Barroso M, Matos P, et al. The use of tourniquet during total knee replacement in patients with and without popliteal artery calcification. Rev Bras Ortop, 2018, 53(2): 165-170.

1. Shi M, Zhang J, Zhang Y, et al. Effect of a 12-hour natural drainage technique on decreasing blood loss after total knee arthroplasty: a case-control study. Ther Clin Risk Manag, 2018, 14: 1169-1174.
2. Gao FQ, Li ZJ, Zhang K, et al. Four methods for calculating blood-loss after total knee arthroplasty. Chin Med J (Engl), 2015, 128(21): 2856-2860.
3. Lohmann-Jensen R, Holsgaard-Larsen A, Emmeluth C, et al. The efficacy of tourniquet assisted total knee arthroplasty on patient-reported and performance-based physical function: a randomized controlled trial protocol. BMC Musculoskelet Disord, 2014, 15: 110.
4. Mayer C, Franz A, Harmsen JF, et al. Soft-tissue damage during total knee arthroplasty: Focus on tourniquet-induced metabolic and ionic muscle impairment. J Orthop, 2017, 14(3): 347-353.
5. Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology, 1983, 58(3): 277-280.
6. Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery, 1962, 51(2): 224-232.
7. Brock TM, Sprowson AP, Muller S, et al. STICKS study-Short-s Tretch Inelastic Compression bandage in Knee Swelling following total knee arthroplasty—a feasibility study. Trials, 2017, 18(1): 6.
8. 徐浩, 王昌耀, 张海宁, 等. 活动平台与固定平台假体行人工全膝关节置换术十年疗效的比较研究. 中国修复重建外科杂志, 2017, 31(3): 271-277.
9. Lindner M, Nosseir O, Keller-Pliessnig A, et al. Psychosocial predictors for outcome after total joint arthroplasty: a prospective comparison of hip and knee arthroplasty. BMC Musculoskelet Disord, 2018, 19(1): 159.
10. 刘德健, 李彦林, 蔡国锋, 等. 3D打印截骨导板辅助人工全膝关节置换术早期疗效分析. 中国修复重建外科杂志, 2018, 32(7): 899-905.
11. Hu Y, Li Q, Wei BG, et al. Blood loss of total knee arthroplasty in osteoarthritis: an analysis of influential factors. J Orthop Surg Res, 2018, 13(1): 325.
12. Bonanzinga T, Tanzi P, Pia Neri M, et al. Evaluation of blood loss and implant alignment after total knee arthroplasty with inertial based extramedullary femoral cutting guide. Joints, 2018, 6(3): 161-166.
13. Dennis DA, Kittelson AJ, Yang CC, et al. Does tourniquet use in TKA affect recovery of lower extremity strength and function? A randomized trial. Clin Orthop Relat Res, 2016, 474(1): 69-77.
14. Dreyer HC. Tourniquet use during knee replacement surgery may contribute to muscle atrophy in older adults. Exerc Sport Sci Rev, 2016, 44(2): 61-70.
15. Ozkunt O, Sariyilmaz K, Gemalmaz HC, et al. The effect of tourniquet usage on cement penetration in total knee arthroplasty: A prospective randomized study of 3 methods. Medicine (Baltimore), 2018, 97(4): e9668.
16. Vaishya R, Agarwal AK, Vijay V, et al. Short term outcomes of long duration versus short duration tourniquet in primary total knee arthroplasty: A randomized controlled trial. J Clin Orthop Trauma, 2018, 9(1): 46-50.
17. Leurcharusmee P, Sawaddiruk P, Punjasawadwong Y, et al. The possible pathophysiological outcomes and mechanisms of tourniquet-induced ischemia-reperfusion injury during total knee arthroplasty. Oxid Med Cell Longev, 2018, 2018: 8087598.
18. Wang C, Zhou C, Qu H, et al. Comparison of tourniquet application only during cementation and long-duration tourniquet application in total knee arthroplasty: a meta-analysis. J Orthop Surg Res, 2018, 13(1): 216.
19. Vivacqua T, Barroso M, Matos P, et al. The use of tourniquet during total knee replacement in patients with and without popliteal artery calcification. Rev Bras Ortop, 2018, 53(2): 165-170.

Chinese Journal of Reparative and Reconstructive Surgery

Effect of pneumatic tourniquet on perioperative blood loss in total knee arthroplasty

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