CC BY 4.0 · Rev Bras Ortop (Sao Paulo) 2024; 59(02): e235-e240
DOI: 10.1055/s-0044-1785204
Artigo Original
Joelho

Can We Forgo the Use of Tourniquets in Total Knee Arthroplasty?

Article in several languages: português | English
1   Faculdade de Medicina, Pontifícia Universidade Católica do Paraná – Câmpus Londrina, Londrina, Paraná, Brasil
2   Hospital de Ortopedia Uniort.e, Londrina, Paraná, Brasil
,
3   Hospital Evangélico de Londrina, Londrina, Paraná, Brasil
,
3   Hospital Evangélico de Londrina, Londrina, Paraná, Brasil
,
1   Faculdade de Medicina, Pontifícia Universidade Católica do Paraná – Câmpus Londrina, Londrina, Paraná, Brasil
,
1   Faculdade de Medicina, Pontifícia Universidade Católica do Paraná – Câmpus Londrina, Londrina, Paraná, Brasil
,
1   Faculdade de Medicina, Pontifícia Universidade Católica do Paraná – Câmpus Londrina, Londrina, Paraná, Brasil
2   Hospital de Ortopedia Uniort.e, Londrina, Paraná, Brasil
› Author Affiliations
Financial Support The authors declare that they did not receive funding from agencies in the public, private, or not-for-profit sectors for the conduction of the present study.

Abstract

Objective To analyze whether there is more bleeding in patients undergoing total knee arthroplasty (TKA) without using a tourniquet. The secondary objectives were to analyze the operative time, the length of hospital stay, the need for transfusion, and the complication rate.

Methods The present is a retrospective study through the analysis of medical records. The patients were divided into two groups: TKA with and without the use of a tourniquet. Reductions in the levels of hemoglobin and packed cell volume 24 h and 48 h after surgery, the operative time, the length of hospital stay, the need for transfusion, and the rate of complications up to 6 months postoperatively were compared between the groups.

Results During the period analyzed, 104 patients underwent TKA, and 94 were included in the study. There were no differences between the groups regarding the mean values of hemoglobin and packed cell volume before surgery (p = 0.675 and p = 0.265), 24 h (p = 0.099 and p = 0.563), and 48 h (p = 0.569 and p = 0.810) after the procedure. Neither were there differences between the groups in terms of the operative time and the length of hospital stay (p = 0.484 and p > 0.05). Moreover, there were no differences regarding the need for transfusion and the complication rate.

Conclusion It is possible to forgo the use a tourniquet in TKA without a significant change in hemoglobin and packed cell volume levels 24 h and 48 h after surgery when compared with the group using a tourniquet. There were no significant differences in the total operative time, length of stay, need for transfusion, and complication rate.

Authors' Contributions

Each author contributed individually and significantly to the development of the present paper. JPFG wrote and reviewed the paper, analyzed the results, developed the statistical analysis, participated in the intellectual conception of the study, and coordinated the entire project; CWJ, BZ, and PMC collected data, wrote, and reviewed the paper; PRB analyzed the results and developed the statistical analysis; MVD reviewed the paper and participated in the intellectual conception of the study.


Work developed at the Hospital Evangélico de Londrina, Hospital de Ortopedia Uniort.e, and the School of Medicine of Pontifícia Universidade Católica do Paraná – Câmpus Londrina, PR, Brazil.




Publication History

Received: 04 March 2023

Accepted: 21 July 2023

Article published online:
10 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 
  • Referências

  • 1 Sun C, Zhang X, Ma Q, Tu Y, Cai X, Zhou Y. Impact of tourniquet during total knee arthroplasty when tranexamic acid was used: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2022; 17 (01) 18
  • 2 Pavão DM, Pires RS, de Faria JLR, Sampaio YD, de Sousa EB, Fogagnolo F. Optimized Tourniquet Use in Primary Total Knee Arthroplasty: A Comparative, Prospective, and Randomized Study. J Arthroplasty 2023; 38 (04) 685-690
  • 3 Berry DJ, Bozic KJ. Current practice patterns in primary hip and knee arthroplasty among members of the American Association of Hip and Knee Surgeons. J Arthroplasty 2010; 25 (6, Suppl) 2-4
  • 4 Zhang W, Li N, Chen S, Tan Y, Al-Aidaros M, Chen L. The effects of a tourniquet used in total knee arthroplasty: a meta-analysis. J Orthop Surg Res 2014; 9 (01) 13
  • 5 Yi Z, Yan L, Haibo S. et al. Effects of tourniquet use on clinical outcomes and cement penetration in TKA when tranexamic acid administrated: a randomized controlled trial. BMC Musculoskelet Disord 2021; 22 (01) 126
  • 6 Chen S, Li J, Peng H, Zhou J, Fang H, Zheng H. The influence of a half-course tourniquet strategy on peri-operative blood loss and early functional recovery in primary total knee arthroplasty. Int Orthop 2014; 38 (02) 355-359 (SICOT)
  • 7 Olivecrona C, Lapidus LJ, Benson L, Blomfeldt R. Tourniquet time affects postoperative complications after knee arthroplasty. Int Orthop 2013; 37 (05) 827-832 (SICOT)
  • 8 Hirota K, Hashimoto H, Tsubo T, Ishihara H, Matsuki A. Quantification and comparison of pulmonary emboli formation after pneumatic tourniquet release in patients undergoing reconstruction of anterior cruciate ligament and total knee arthroplasty. Anesth Analg 2002; 94 (06) 1633-1638
  • 9 Din R, Geddes T. Skin protection beneath the tourniquet. A prospective randomized trial. ANZ J Surg 2004; 74 (09) 721-722
  • 10 Cai DF, Fan QH, Zhong HH, Peng S, Song H. The effects of tourniquet use on blood loss in primary total knee arthroplasty for patients with osteoarthritis: a meta-analysis. J Orthop Surg Res 2019; 14 (01) 348
  • 11 Ahmed I, Chawla A, Underwood M. et al. Time to reconsider the routine use of tourniquets in total knee arthroplasty surgery. Bone Joint J 2021; 103-B (05) 830-839
  • 12 Fillingham YA, Ramkumar DB, Jevsevar DS. et al. The Efficacy of Tranexamic Acid in Total Knee Arthroplasty: A Network Meta-Analysis. J Arthroplasty 2018; 33 (10) 3090-3098.e1
  • 13 Alexandersson M, Wang EY, Eriksson S. A small difference in recovery between total knee arthroplasty with and without tourniquet use the first 3 months after surgery: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc 2019; 27 (04) 1035-1042
  • 14 Zak SG, Yeroushalmi D, Long WJ, Meftah M, Schnaser E, Schwarzkopf R. Does the Use of a Tourniquet Influence Outcomes in Total Knee Arthroplasty: A Randomized Controlled Trial. J Arthroplasty 2021; 36 (07) 2492-2496
  • 15 Zhao HY, Yeersheng R, Kang XW, Xia YY, Kang PD, Wang WJ. The effect of tourniquet uses on total blood loss, early function, and pain after primary total knee arthroplasty: a prospective, randomized controlled trial. Bone Joint Res 2020; 9 (06) 322-332
  • 16 El-Galaly A, Hansen AT, Kappel A. The use of tourniquet in primary total knee arthroplasty does not increase the risk of venous thromboembolism within 90 days of surgery: a Danish nationwide cohort study of 19,804 patients. Knee Surg Sports Traumatol Arthrosc 2023; 31 (03) 883-891
  • 17 Ludwick L, Shohat N, Sherman MB, Paladino J, Ledesma J, Fillingham Y. The Use of Cement and Tourniquet During Total Knee Arthroplasty Does Not Increase the Risk of Venous Thromboembolism Postoperatively. Arthroplast Today 2022; 17: 211-217.e1
  • 18 Sun C, Yang X, Zhang X. et al. Personalized tourniquet pressure may be a better choice than uniform tourniquet pressure during total knee arthroplasty: A PRISMA-compliant systematic review and meta-analysis of randomized-controlled trials. Medicine (Baltimore) 2022; 101 (08) e28981