PDF icon PDF herunterladen
J Knee Surg 2022; 35(06): 698-706
DOI: 10.1055/s-0041-1740926
Original Article

A Randomized Controlled Study on the Use of Tourniquet in Primary Total Knee Arthroplasty

Chaofan Zhang
1   Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
2   Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
3   Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
,
Chun Hoi Yan
1   Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
2   Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
,
Ping Keung Chan
1   Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
2   Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
,
Henry Fu
1   Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
2   Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
,
Kwong Yuen Chiu
1   Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
2   Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
› Institutsangaben
Funding This study was funded by the internal research fund from the Department of Orthopaedics and Traumatology, the University of Hong Kong.
› Weitere Informationen
   Lizenzen und Reprints
Preview

Abstract

Background The use and the optimal timing of tourniquet during primary total knee arthroplasty (TKA) is controversial. Most previous studies failed to show clinically significant differences in different strategies. The aim of this study was to determine how three strategies of tourniquet application affect the outcome in TKA patients.

Methods This was a prospective randomized controlled study. Patients who undergo TKA were randomized into one of the three groups (1:1:1 ratio): tourniquet inflated from skin incision to cement hardening, tourniquet from cement application to hardening, and tourniquet from skin incision to skin closure. The perioperative blood loss, limb swelling, and complications were recorded. The level of hemoglobin, hematocrit, C-reactive protein (CRP), interleukin (IL)-6, creatine kinase (CK), and lactate dehydrogenase (LDH) were determined. Patients' thigh and TKA wound pain, Knee Society knee score (KSKS) and Knee Society functional assessment (KSFA) scores, and rehabilitation parameters were evaluated.

Results A total of 90 patients were enrolled. The baseline characteristics were comparable. We only found significant difference in the intraoperative blood loss (skin to cement: 58.7 ± 36.1 mL, cement-only: 147.8 ± 107.9 mL, skin to skin: 16.3 ± 13.1 mL, p < 0.0001). There were no statistical differences in postoperative drainage, thigh/knee circumference, change of hemoglobin/hematocrit, CRP, IL-6, CK, and LDH on day 1 to day 4 after surgery. The thigh/TKA wound Visual Analogue Scale scores, KSKS score, KSFA score, and rehabilitation parameters were not significantly different at up to 6-month follow-up. No thromboembolic events were noted.

Conclusion Our results revealed that there was no best tourniquet strategy in TKA. Different tourniquet methods can be utilized based on surgeon preference without affecting outcomes.

Keywords

total knee arthroplasty - randomized controlled study - tourniquet - perioperative blood loss - rehabilitation

Ethical Approval

Each author certified that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. The protocol was approved by our institutional review board (HKU/HA HKW IRB number: UW 15 -129). This randomized controlled trial has been registered at clinicaltrials.gov (registration number: NCT04502459).




Publikationsverlauf

Eingereicht: 07. Oktober 2020

Angenommen: 16. November 2021

Artikel online veröffentlicht:
03. Januar 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA