EFFICIENCY AND SAFETY OF TOURNIQUET DURING TOTAL KNEE ARTHROPLASTY: WHEN TO PERFORM RELEASE?

Cover Page


Cite item

Full Text

Abstract

Use of a pneumatic tourniquet during total knee arthroplasty is an effective option allowing reduction of the time of surgery and intraoperative blood loss. At the same time, there are a lot of researchers who advocate differing tactical approaches to the duration of the tourniquet application — the so-called “early” and “late” releases.

Purpose of the study. To assess the effectiveness and safety of various methods of tourniquet use during primary total knee arthroplasty.

Material and methods. 72 patients with end-stage knee osteoarthritis were randomly divided into two equal prospective groups: 1) keeping the tourniquet throughout the surgery, including wound closure (late release); 2) performing knee arthroplasty using the tourniquet until after implantation of the prosthesis component and implementation of hemostasis after the release of the tourniquet (early release). Such aspects as perioperative blood loss and changes in blood counts, blood transfusion volume, and severity of pain on the VAS scale, the rate of recovery of the knee joint function and number of postoperative complications were assessed during hospital stay of patients.

Results. The duration of procedures was 70±15,4 min for the Group I with tourniquet throughout surgery (late release) and 95±27,5 for the Group II with early release (p = 0,001). On the 7th day after the arthroplasty the authors observed statistically significant differences (p<0,05) in the dynamics of reducing the level of hemoglobin, red blood cells and hematocrit in patients of compared groups — in patients who underwent late release of the tourniquet, these indicators were higher. When assessing the rate of recovery of knee joint function according to the KSS -and the intensity of the pain syndrome no significant statistical differences were found in the patients of both groups.

Conclusion. Application of the tourniquet throughout the surgery to release after closure of the surgical wound does not lead to a sharp increase in the number of ischemic and thromboembolic complications, while at the same time, the application of this methodology to a large extent maintains hemoglobin indicators, red blood cells and hematocrit at a high level without a critical decrease.

About the authors

D. V. Chugaev

Vreden Russian Research Institute of Traumatology and Orthopedics

Author for correspondence.
Email: dr.chugaev@gmail.com

Dmitry V. Chugaev — Researcher, Orthopaedic Surgeon, Trauma and Orthopaedic Department N 7, Vreden Russian Research Institute of Traumatology and Orthopedics.

8, ul. Akad. Baykova, St. Petersburg, 195427 Россия

N. N. Kornilov

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Nikolai N. Kornilov — Dr. Sci. (Med.), Leading Researcher, Knee Pathology Department, Vreden Russian Research Institute of Traumatology and Orthopaedics.

8, ul. Akad. Baykova, St. Petersburg, 195427 Россия

P. G. Kogan

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Pavel G. Kogan — Researcher, Orthopaedic Surgeon, Trauma and Orthopaedic Department N 7, Vreden Russian Research Institute of Traumatology and Orthopedics.

8, ul. Akad. Baykova, St. Petersburg, 195427 Россия

References

  1. Olivecrona C., Tidermark J., Hamberg P., Ponzer S., Cederfjäll C. Skin protection underneath the pneumatic tourniquet during total knee arthroplasty: A randomized controlled trial of 92 patients. Acta Orthop. 2006;77(3):519-523. doi: 10.1080/17453670610012539.
  2. Din R., Geddes T. Skin protection beneath the tourniquet a prospective randomized trial. ANZ J Surg. 2004;74(9): 721-722. doi: 10.1111/j.1445-1433.2004.03143.x.
  3. Mayer C., Franz A., Harmsen J.-F., Queitsch F., Behringer M., Beckmann J., Krauspe R., Zilkens C. Soft-tissue damage during total knee arthroplasty. J Orthop. 2017;14(3):347-353. doi: 10.1016/j.jor.2017.06.015.
  4. Abdel-Salam A., Eyres K.S. Effects of tourniquet during total knee arthroplasty. A prospective randomised study. J Bone Joint Surg Br. 1995;77(2):250-253.
  5. Yi S., Tan J., Chen C., Chen H., Huang W. The use of pneumatic tourniquet in total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg. 2014;134(10): 1469-1476. doi: 10.1007/s00402-014-2056-y.
  6. Guler O., Mahirogullari M., Isyar M., Piskin A., Yalcin S., Mutlu S., Sahin B. Comparison of quadriceps muscle volume after unilateral total knee arthroplasty with and without tourniquet use. Knee Surgery, Sport Traumatol Arthrosc. 2016;24(8):2595-2605. doi: 10.1007/s00167-015-3872-5.
  7. Rama K.R.B.S., Apsingi S., Poovali S., Jetti A. Timing of tourniquet release in knee arthroplasty. Meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. 2007;89(4):699-705. doi: 10.2106/JBJS.F.00497.
  8. Vertullo C.J., Nagarajan M. Is cement penetration in TKR reduced by not using a tourniquet during cementation? A single blinded, randomized trial. J Orthop Surg. 2017;25(1):230949901668432. doi: 10.1177/2309499016684323.
  9. Verburg H., van de Ridder L.C., Verhoeven V.W.J., Pilot P. Validation of a measuring technique with computed tomography for cement penetration into trabecular bone underneath the tibial tray in total knee arthroplasty on a cadaver model. BMC Med Imaging. 2014;14(1):29. doi: 10.1186/1471-2342-14-29.
  10. Huang Z.Y., Pei F.X., Ma J., Yang J., Zhou Z.K., Kang P. De, Shen B. Comparison of three different tourniquet application strategies for minimally invasive total knee arthroplasty: a prospective non-randomized clinical trial. Arch Orthop Trauma Surg. 2014;134(4):561-570. doi: 10.1007/s00402-014-1948-1.
  11. Zhang P., Liang Y., He J., Fang Y., Chen P., Wang J. Timing of tourniquet release in total knee arthroplasty: A metaanalysis. Medicine (Baltimore). 2017;96(17):e6786. doi: 10.1097/MD.0000000000006786.
  12. Lee Q.J., Mak W.P., Hau W.S., Yeung S.T., Wong Y.C., Wai Y.L. Short duration and low suction pressure drain versus no drain following total knee replacement. J Orthop Surg (Hong Kong). 2015;23(3):278-281. doi: 10.1177/230949901502300302.
  13. Чугаев Д.В., Корнилов Н.Н., Сорокин Е.П. Современные хирургические аспекты кровосбережения в тотальном эндопротезировании коленного сустава (обзор). Саратовский научно-медицинский журнал. 2017;13(2):273-279. Chugaev D.V., Kornilov N.N., Sorokin E.P. [Modern surgical aspects in blood loss management in total knee arthroplasty]. Saratovskij nauchno-medicinskij zhurnal [Saratov Journal of Medical Scientific Research] 2017;13(2):273-279. (in Russian).
  14. Papalia R., Zampogna B., Franceschi F., Torre G., Maffulli N., Denaro V. Tourniquet in knee surgery. Br Med Bull. 2014;111(1):63-76. doi: 10.1093/bmb/ldu012.
  15. Власов С.В., Сафронов Н.Ф., Власова И.В., Тлеубаева Н.В. Факторы риска тромбогеморрагических осложнений при эндопротезировании коленного сустава. Политравма. 2009;(2):36-41. Vlasov S.V., Safronov N.F., Vlasova I.V., Tleubaeva N.V. [Risk factors of thrombohemorrhagic complications in knee joint endoprosthesis]. Politravma [Polytrauma]. 2009;(2):36-41. (in Russian).
  16. Huang Z., Ma J., Zhu Y., Pei F., Yang J., Zhou Z., Kang P., Shen B. Timing of tourniquet release in total knee arthroplasty. Orthopedics. 2015;38(7):445-451. doi: 10.1097/MD.0000000000006786.
  17. Куляба Т.А., Корнилов Н.Н. Артропластика коленного сустава. СПб.: РНИИТО им. Р.Р. Вредена, 2012. 228 p. Kulyaba T.A., Kornilov N.N. Artroplastika kolennogo sustava [Total knee arthroplasty]. St. Petersburg: RNIITO im. R.R. Vredena, 2012. 228 p. (in Russian).
  18. Чугаев Д.В., Корячкин В.А., Корнилов Н.Н., Сорокин Е.П. Нехирургические методики кровосбережения у больных при тотальном эндопротезировании коленного сустава (обзор литературы). Трансфузиология. 2017;18(1):23-28. Chugaev D.V., Koryachkin V.A., Kornilov N.N., Sorokin E.P. [Nonsurgical blood loss management technique in patients with total knee arthroplasty (Literature review)]. Transfuziologija [Transfusiology]. 2017;18(1):23-28. (in Russian).
  19. Yildiz C., Koca K., Kocak N., Tunay S., Basbozkurt M. Late tourniquet release and drain clamping reduces postoperative blood loss in total knee arthroplasty. HSS J. 2014;10(1):2-5. doi: 10.1007/s11420-013-9363-7.
  20. Tai T.-W., Yang C.-Y., Jou I.-M., Lai K.-A., Chen C.-H. Temporary drainage clamping after total knee arthroplasty: a meta-analysis of randomized controlled trials. J Arthroplasty. 2010;25(8):1240-1245. doi: 10.1016/j.arth.2009.08.013.
  21. Padala P.R., Rouholamin E., Mehta R.L. The role of drains and tourniquets in primary total knee replacement: a comparative study of TKR performed with drains and tourniquet versus no drains and adrenaline and saline infiltration. J Knee Surg. 2004;17(1):24-27.
  22. Oh C.-S., Kim S.-H., Lee J., Rhee K.Y. Impact of remote ischaemic preconditioning on cerebral oxygenation during total knee arthroplasty. Int J Med Sci. 2017;14(2):115-122. doi: 10.7150/ijms.17227.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c)


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 82474 от 10.12.2021.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies