Effect of different tourniquet technologies on the recovery of affected limb function in total knee arthroplasty

doi:10.3969/j.issn.2095-4344.2014.53.006

Abstract

Abstract:

BACKGROUND: It is controversial whether it is necessary to use inflatable tourniquet during total knee arthroplasty. How to correctly use inflatable tourniquet, how to provide a good environment for bone cement and bone using inflatable tourniquet and simultaneously to reduce clinical complications using inflatable tourniquet have become a hot focus in the clinic.
OBJECTIVE: To evaluate the effects of different tourniquet technologies on affected limb function after unilateral total knee arthroplasty.
METHODS: A total of 40 patients who received unilateral total knee arthroplasty at the Department of Joint Surgery, Subei People’s Hospital from January to December 2013 were divided into halfway tourniquet group and omnidistance tourniquet group (n=20). The length of surgery, length of tourniquet, perioperative blood loss, postoperative complication and Hospital for Special Surgery knee score were used to evaluate the early clinical effects using the two tourniquet technologies.
RESULTS AND CONCLUSION: Perioperative blood loss was significantly more in the halfway tourniquet group than in the omnidistance tourniquet group (P < 0.05). The drainage was significantly less in the halfway tourniquet group than in the omnidistance tourniquet group after replacement (P < 0.05). No significant difference in the overt blood loss was detectable between the two groups (P > 0.05). The postoperative wound inflammation days were significantly less in the halfway tourniquet group than in the omnidistance tourniquet group (P < 0.05). Hospital for Special Surgery knee score was significantly higher in the halfway tourniquet group than in the omnidistance tourniquet group at 2 weeks after replacement (P < 0.05). No significant differences in Hospital for Special Surgery knee score were visible between the two groups at 6 months after replacement (P > 0.05). No complications, such as joint hematoma, deep vein thrombosis, or pulmonary embolism appeared in both groups. These data suggest that during total knee arthroplasty, halfway tourniquet can lessen knee swelling or surrounding tissue pain, and evidently improve early clinical symptoms and limb function after replacement.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: arthroplasty, replacement, knee, blood loss, surgical, drainage

CLC Number:

R318

Wang Qiang1, Li Xiao-lei, Wang Qi, Yan Lian-qi, Sun Yu, Xiong Chuan-zhi, Hu Han-sheng, Chen Gang . Effect of different tourniquet technologies on the recovery of affected limb function in total knee arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(53): 8560-8564.

Figures/Tables 1

References

[1] Tahmasebi MN, Bashti K, Ghorbani G, et al. Intraarticular Administration of Tranexamic Acid Following Total Knee Arthroplasty: A Case-control Study. Arch Bone Jt Surg. 2014; 2(3):141-145.
[2] Feng B, Weng X, Lin J,et al. Long term follow up of clinical outcome between patellar resurfacing and nonresurfacing in total knee arthroplasty: Chinese experience. Chin Med J (Engl). 2014;127(22):3845-3851.
[3] Liu J, Li XF, Xu KL, et al.Bilateral Total Knee Arthroplasty for Charcot Knees Associated with Tabes Dorsalis. Pain Physician. 2014;17(6):E796-799.
[4] Marya SK, Thukral R. Outcome of unicompartmental knee arthroplasty in octogenarians with tricompartmental osteoarthritis: A longer followup of previously published report. Indian J Orthop. 2013;47(5):459-468.
[5] Tarwala R, Dorr LD, Gilbert PK, et al. Tourniquet use during cementation only during total knee arthroplasty: a randomized trial. Clin Orthop Relat Res. 2014;472(1):169-174.
[6] 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.
[7] Dutton T, De-Souza R, Parsons N, et al. The timing of tourniquet release and 'retransfusion' drains in total knee arthroplasty: A stratified randomized pilot investigation. Knee. 2012;19(3):190-192.
[8] 沈忠伟,童培建,邵营钢,等.止血带对全膝关节置换术后肿胀及功能影响的临床研究[J].浙江临床医学,2010,12(3):261-262.
[9] Lee KJ, Moon JY, Song EK, et al. Minimum Two-year Results of Revision Total Knee Arthroplasty Following Infectious or Non-infectious Causes.Knee Surg Relat Res. 2012;24(4): 227-234.
[10] Causero A, Di Benedetto P, Beltrame A, et al. Design evolution in total knee replacement: which is the future? Acta Biomed. 2014;85(2):5-19.
[11] Haidukewych GJ, Petrie JR, Adigweme O. The multiply- operated total knee replacement patient: salvage options. Bone Joint J. 2014;6-B(11 Supple A):122-124.
[12] Kvederas G, Porvaneckas N, Andrijauskas A, et al. randomized double-blind clinical trial of tourniquet application strategies for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2013;21(12):2790-9.
[13] Huang ZY, Pei FX, Ma J, et al. 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.
[14] Ishii Y, Noguchi H, Matsuda Y, et al. A new tourniquet system that determines pressures in synchrony with systolic blood pressure in total knee arthroplasty. J Arthroplasty. 2008;23(7): 1050-1056.
[15] Tomita M, Motokawa S. Effects of air tourniquet on the antibiotics concentration, in bone marrow, injected just before the start of operation. Mod Rheumatol. 2007;17(5):409-412.
[16] Tetro AM, Rudan JF. The effects of a pneumatic tourniquet on blood loss in total knee arthroplasty. Can J Surg. 2001;44(1): 33-38.
[17] Christodoulou AG, Ploumis AL, Terzidis IP, et al. The role of timing of tourniquet release and cementing on perioperative blood loss in total knee replacement. Knee. 2004;11(4): 313-317.
[18] Rama KR, Apsingi S, Poovali S, et al. Timing of tourniquet release in knee arthroplasty. Meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. 2007;89(4):699-705.
[19] Ostman B, Michaelsson K, Rahme H, et al. Tourniquet-induced ischemia and reperfusion in human skeletal muscle. Clin Orthop Relat Res. 2004;418:260-265.
[20] Westman B, Weidenhielm L, Rooyackers O, et al. Knee replacement surgery as a human clinical model of the effects of ischaemia/reperfusion upon skeletal muscle. Clin Sci(Lond). 2007;113(7):313-318.
[21] Eum DS, Lee HK, Hwang SY, et al. Blood loss after navigation-assisted minimally invasive total knee arthroplasty. Orthopedics. 2006;29:S152-S154.
[22] Yamaguchi S, Ohno G, Kitamura J. Evaluation of perioperative blood loss and transfusion in total knee arthroplasty. Masui. 2014;63(9):1029-1033.
[23] Lotke PA, Faralli VJ, Orenstein EM, et al. Blood loss after total knee replacement. Effects of tourniquet release and continuous passive motion. J Bone Joint Surg Am. 1991;73(7): 1037-1040.
[24] 闫昌葆,陈百成,赵宝辉,等.全膝关节置换术中止血带不同使用方法的早期临床效果比较[J].中国矫形外科杂志,2009,17(8): 597-599.
[25] 中华医学会骨科学分会.中国骨科大手术静脉血栓栓塞症预防指南[J/CD].中华关节外科杂志:电子版,2009,3(3):70-72.
[26] Kato N, Nakanishi K, Yoshino S, et al. Abnormal echogenic findings detected by transesophageal echocardiography and cardiorespiratory impairment during total knee arthroplasty with tourniquet. Anesthesiology. 2002;97(5):1123-1128.
[27] 王俊丰,闻久全,蒋阅.膝关节置换术中选择性使用止血带的疗效观察[J].中国伤残医学,2014,22(6):9-11.
[28] Hirota K, Hashimoto H, Kabara S, et al. The relationship between pneumatic tourniquet time and the amount of pulmonary emboli in patients undergoing knee arthroscopic surgeries. Anesth Analg. 2001;93(3):776-780.
[29] Shaikh N, Parchani A, Bhat V, et al. Fat embolism syndrome: clinical and imaging considerations: case report and review of literature. Indian J Crit Care Med. 2008;12(1):32-36.
[30] Westrich GH, Haas SB, Mosca P, et al. Meta-analysis of thromboembolic prophylaxis after total knee arthroplasty. J Bone Joint Surg Br. 2000;82(6):795-800.
[31] Wauke K, Nagashima M, Kato N, et al. Comparative study between thromboembolism and total knee arthroplasty with or without tourniquet in rheumatoid arthritis patients. Arch Orthop Trauma Surg. 2002;122(8):442-446.