Absence of a tourniquet during total knee arthroplasty: a prospective randomized controlled trial

doi:10.12307/2022.790

Abstract

Abstract: BACKGROUND: Total knee arthroplasty is the most effective method for the treatment of end-stage knee osteoarthritis, but whether to use tourniquets during total knee arthroplasty remains controversial in academic circles.
OBJECTIVE: To investigate the effect of tourniquet on postoperative clinical efficacy and imaging results during total knee arthroplasty.
METHODS: From September 2019 to September 2020, a prospective, randomized, controlled study was conducted in patients who underwent primary total knee arthroplasty for degenerative osteoarthritis. All patients were treated with cement-based prosthesis of the same design, and were randomly divided into intraoperative tourniquet use group (control group) and no tourniquet use group (trial group). To make clinical data comparable, the same follow-up time point was set for both groups, 12 months after surgery. A total of 100 cases (49 cases in the trial group; 51 cases in the control group) were included in the final analysis to evaluate the clinical efficacy, penetration depth of bone cement, and incidence of postoperative complications.
RESULTS AND CONCLUSION: (1) The operation was successfully completed in both groups. The release rate of external patellar retinacular band was lower in the trial group (0 cases) than that in the control group (6 cases) (P=0.040). (2) The visual analogue scale score of the trial group on the 7th postoperative day was lower than that of the control group (P=0.00). Visual analogue scale score between the trial group and the control group had no statistical significance 1 month after surgery (P=0.61). (3) There was no significant difference in the range of motion at 12 months and KSS score at 1 month between the trial group and the control group. (4) X-ray examination 2 days after the operation showed that the penetration depth of bone cement was similar between the two groups (P=0.281). (5) At 12 months after the operation, there was no periprosthetic infection, prosthesis loosening or symptomatic thrombosis in both groups. (6) It is indicated that whether to use tourniquets during primary total knee arthroplasty does not affect penetration depth of bone cement or clinical effect. However, the use of tourniquet can increase the degree of pain within 7 days after operation and the release rate of external patellar retinacular band.

Key words: osteoarthritis, total knee arthroplasty, tourniquet, bone cement penetration, follow-up

CLC Number:

Ma Qiaoqiao, Wu Zerui, Guo Zhuotao, Zhang Kai, Zha Guochun, Guo Kaijin. Absence of a tourniquet during total knee arthroplasty: a prospective randomized controlled trial[J]. Chinese Journal of Tissue Engineering Research, 2022, 26(36): 5831-5836.

Figures/Tables 6

References

[1] ROYECA JM, CUNNINGHAM CM, PANDIT H, et al. Complex regional pain syndrome as a result of total knee arthroplasty: A case report and review of literature. Case Rep Womens Health. 2019;23:e00136.
[2] LU C, SONG M, CHEN J, et al. Does tourniquet use affect the periprosthetic bone cement penetration in total knee arthroplasty? A meta-analysis. J Orthop Surg Res. 2020;15(1):602.
[3] CAWLEY DT, KELLY N, MCGARRY JP, et al. Cementing techniques for the tibial component in primary total knee replacement. Bone Joint J. 2013;95-b(3):295-300.
[4] HOFMANN AA, GOLDBERG TD, TANNER AM, et al. Surface cementation of stemmed tibial components in primary total knee arthroplasty: minimum 5-year follow-up. J Arthroplasty. 2006;21(3):353-357.
[5] ARTHUR JR, SPANGEHL MJ. Tourniquet Use in Total Knee Arthroplasty. J Knee Surg. 2019;32(8):719-729.
[6] 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(5):830-839.
[7] MAISTRELLI GL, ANTONELLI L, FORNASIER V, et al. Cement penetration with pulsed lavage versus syringe irrigation in total knee arthroplasty. Clin Orthop Relat Res. 1995;312:261-265.
[8] ARGENSON JN, PARRATTE S, ASHOUR A, et al. The outcome of rotating-platform total knee arthroplasty with cement at a minimum often years of follow-up. J Bone Joint Surg Am. 2012;94:638-644.
[9] FENG B, WENG X, LIN J, et al. Long-term follow-up of cemented fixed-bearing total knee arthroplasty in a Chinese population: a survival analysis of more than 10 years. J Arthroplasty. 2013;28:1701-1706.
[10] PETERS CL, CRAIG MA, MOHR RA, et al. Tibial component fixation with cement: full- versus surface-cementation techniques. Clin Orthop Relat Res. 2003;409:158-168.
[11] EWALD FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989;248:9-12.
[12] GOMES LS, BECHTOLD JE, GUSTILO RB. Patellar prosthesis positioning in total knee arthroplasty. A roentgenographic study. Clin Orthop Relat Res. 1988;(236):72-81.
[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] PARVIZI J, DIAZ-LEDEZMA C. Total knee replacement with the use ofa tourniquet: more pros than cons. Bone Joint J. 2013;95:133-134.
[15] CHEN S, LI J, PENG H, et al. 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;38:355-359.
[16] FENG L, ZHANG XG, YANG QG, et al. Effects of tourniquet on cardiac function in total knee arthroplasty with trans-esophageal echocardiography. Zhonghua Yi Xue Za Zhi.2013;93:3755-3757.
[17] ZHANG W, LI N, CHEN S, et al. The effects of a tourniquet used in total knee arthroplasty: a metaanalysis. J Orthop Surg Res. 2014;9:13.
[18] LEDIN H, ASPENBERG P, GOOD L. Tourniquet use in total knee replacement does not improve fixation, but appears to reduce final range of motion. Acta Orthop. 2012;83:499-503.
[19] TAI TW, CHANG CW, LAI KA, et al. Effects of tourniquet use on blood loss and soft-tissue damage in total knee arthroplasty: A randomized controlled trial. J Bone Joint Surg Am. 2012; 94(24):2209-2215.
[20] LI B, WEN Y, WU H, et al. The effectof tourniquet use on hidden blood loss in total knee arthroplasty. Int Orthop. 2009;33(5):1263-1268.
[21] HARRIS LW, REID D, POWERS SK, et al. Tourniquet-induced skeletal muscle oxidative injury during lower limb orthopaedic trauma surgery. Bone Jt J. 2011;93:557.
[22] PFITZNER T, VON ROTH P, VOERKELIUS N, et al. Influence of the tourniquet on tibial cement mantle thickness in primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2016;24:96-101.
[23] BANWART JC, MCQUEEN DA, FRIIS EA, et al. Negative pressure intrusion cementing technique for total knee arthroplasty. J Arthroplasty. 2000; 15:360-367.
[24] JAWHAR A, STETZELBERGER V, KOLLOWA K, et al. Tourniquet application does not affect the periprosthetic bone cement penetration in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2019; 27(7):2071-2081.
[25] MITTAL R, KO V, ADIE S, et al. Tourniquet application only during cement fxation in total knee arthroplasty: a double-blind, randomized controlled trial. ANZ J Surg. 2012;82:428-433.
[26] HASANAIN MS, APOSTU D, ALREFAEE A, et al. Comparing the effect of tourniquet vs tourniquet-less in simultaneousbilateral total knee arthroplasties. J Arthroplasty. 2018;33:2119-2124.
[27] KUMAR N, YADAV C, SINGH S, et al. Evaluation of pain in bilateral total knee replacement withand without tourniquet; a prospective randomized control trial. J Clin Orthop Trauma. 2015;6:85-88.
[28] EJAZ A, LAURSEN AC, KAPPEL A, et al. Faster recovery without the use of a tourniquet in total knee arthroplasty. Acta Orthop. 2014;85:422-426.
[29] ALEXANDERSSON M, WANG EY, ERIKSSON S. A small difference in recovery between total knee arthroplasty with and without tourniquet use the frst 3 months after surgery: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc. 2019;27:1035-1042.
[30] HELLER S, CHEN A, RESTREPO C, et al. Tourniquet release prior to dressing application reduces blistering following total knee arthroplasty. J Arthroplasty.2015;30(7):1207-1210.
[31] KOMATSU T, ISHIBASHI Y, OTSUKA H, et al. The effect of surgicall approache sand tourniquet tapplication on patella femoral tracking in total knee arthroplasty. J Arthroplasty. 2003;18(3):308-312.
[32] 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.