Usage strategy of optimized tourniquet in enhanced recovery after total knee arthroplasty

doi:10.3969/j.issn.2095-4344.1220

Abstract

Abstract:

BACKGROUND: Tourniquets used in total knee arthroplasty can reduce intraoperative bleeding, maintain clear surgical field, and increase the stability of the prosthesis, but can cause adverse reactions such as ischemia/reperfusion injury, local paralysis of the tourniquet, swelling, and pain. Therefore, how to optimize the usage strategy during surgery to maximize the benefit of tourniquet application has become a hotspot.

OBJECTIVE: To compare and analyze the effects of different tourniquet usage strategies on enhanced recovery after total knee arthroplasty.

METHODS: Eighty-six patients with osteoarthritis who underwent primary total knee arthroplasty at Affiliated Hospital of Nanjing University of Chinese Medicine from July 2017 to May 2018 were randomly divided into two groups. Whole process group used tourniquet in the whole process from cut to prosthesis implantation (n=43) and optimized group used tourniquet only when the prosthesis was implanted (n=43). The operation time, tourniquet usage time, and blood loss were recorded. The swelling degree of knee joint at postoperative 1, 3, 5, and 7 days was measured. The Hospital for Special Surgery score, Visual Analog Scale score, Hamilton Anxiety and Depression Scale, and social objective and subjective support score were detected before discharge.

RESULTS AND CONCLUSION: (1) There was no significant difference in the operation time between two groups (P > 0.05). The tourniquet usage time in the whole process group was significantly longer than that in the optimized group (P < 0.05). (2) There was insignificant difference in the total blood loss between two groups. The intraoperative blood loss in the whole process group was significantly less than that in the optimized group (P < 0.05), and the postoperative drainage volume and hidden blood loss were more than those in the optimized group (P < 0.05). (3) The swelling degree of knee joint at postoperative 3 and 5 days in the optimized group was significantly lower than that in the whole process group (P < 0.05). (4) The Hospital for Special Surgery score, and social objective and subjective support score in the optimized group were significantly higher than those in the whole process group, and the Visual Analog Scale score, and Hamilton Anxiety and Depression Scale were significantly lower than those in the whole process group (P < 0.05). (5) There was no significant difference in the incidence of complications between two groups (P > 0.05). (6) Our results manifest that optimization of tourniquet usage can reduce hidden blood loss, alleviate postoperative pain, inflammation reaction and swelling degree, and effectively control patients, negative emotions.

Key words: knee arthroplasty, tourniquet, enhanced recovery, tourniquet usage strategy, blood loss, optimized tourniquet usage, enhanced recovery after surgery, knee joint function

CLC Number:

R459.9|R684|R318

Peng Chenjian, Du Bin, Sun Guangquan, Liu Xin, He Bing. Usage strategy of optimized tourniquet in enhanced recovery after total knee arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(28): 4451-4455.

Figures/Tables 4

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