The timing of tourniquet release: its influence on blood loss and possible complications after total knee arthroplasty. A prospective multicenter study

Valentí, J.R.; Mora, G.; Amillo, S.; Montserrat, F.; Hinarejos, P.; Vaquero, J.; Leyes, M.; Gamelas, J.

doi:10.1016/S1988-8856(08)70098-1

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Abstract

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Purpose

We conducted a prospective multicenter study with alternate selection methodology in order to evaluate postoperative blood loss further to primary knee replacement at the time of tourniquet release, with or without hemostasis, as well as possible local and systemic complications.

Materials and methods

We studied 194 patients (194 knees) divided into two similar groups. Group I (Hemostasis - H) - the tourniquet was deflated intraoperatively after implantation of the metal components and hemostasis was achieved prior to wound closure. Group II (No Hemostasis - NH) - the tourniquet was released after the wound was closed and a compressive bandage applied.

Results

Mean bleeding was 721ml (30-1540) for group I and 625 ml (60-1540) for group II. No statistically significant differences were found (p = 0.3). No significant differences were found between the groups as regards general or local complications.

Conclusions

Postoperative blood loss is not related directly with the time of tourniquet release further to TKR. Our findings cast certain doubts on the efficacy of tourniquet release, which means that intraoperative hemostasis may not be necessary.

Key words:

intraoperative hemostasis

ischemia

tourniquet

total knee replacement

complications

Objetivo

Realizar un estudio prospectivo multicéntrico de selección alternante para valorar las pérdidas hemáticas postoperatorias de la prótesis total de rodilla en relación con el momento de soltar la isquemia, realizando o no hemostasia, y las posibles complicaciones locales y generales.

Material y método

Se analizan 194 pacientes (194 rodillas) distribuidos en dos grupos homogéneos:

1.
Grupo I hemostasia (H): se libera el torniquete de isquemia después de la colocación de los implantes metálicos, realizando la hemostasia previa al cierre de la herida quirúrgica.
2.
Grupo II no hemostasia (NH): se coloca la prótesis, se realiza el cierre de la herida quirúrgica, se coloca vendaje compresivo y en este momento se afloja el manguito neumático.

Resultados

El sangrado promedio total del grupo I (H) fue de 721cc. (30-2210) y el del grupo II (NH) fue de 625cc. (60-1540), no existiendo diferencias significativas entre ambos grupos (p = 0,3). No se encuentran tampoco diferencias significativas entre ambos grupos con respecto a las complicaciones locales o generales.

Conclusión

Las pérdidas hemáticas postoperatorias no se relacionan directamente con el momento de soltar la isquemia durante las prótesis totales de rodilla.

Palabras clave:

hemostasia intraoperatoria

isquemia

torniquete

prótesis total de rodilla

complicaciones

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References

[1.]

A. Abdel-Salam, K.S. Eyres.

Effects of tourniquet during total knee arthroplaty. A prospective randomised study.

J Bone Joint Surg Br, 77 (1995), pp. 250-253

Medline

[2.]

K.S. Eyres, I. Sharpe, A. Abdel-Salam.

The tourniquet in total knee arthroplasty.

J Bone Joint Surg Br, 81B (1999), pp. 932

[3.]

A.M. Tetro, J.K. Rudan.

The effects of a pneumatic tourniquet on blood lose in total knee arthroplasty.

Can J Surg, 44 (2001), pp. 33-38

Medline

[4.]

R. Iorio, W.L. Healy.

Tourniquet use during total knee arthroplasty did not reduce total blood loss.

J Bone Joint Surg Am, 83A (2001), pp. 1282

[5.]

P.A. Lotke, V.J. Faralli, E.M. Orenstein, M.L. Ecker.

Blood loss after total knee replacement. Effects of tourniquet release and continuous passive motion.

J Bone Jont Surg Am, 73A (1991), pp. 1037-1040

[6.]

E. Vandenbussche, L.D. Duranthon, M. Couturier, L. Pidhorz, B. Augereau.

The effect of tourniquet use in total knee arthroplasty.

Int Ortop, 26 (2002), pp. 306-309

[7.]

H.M. Wakankar, J.E. Nicholl, R. Koka, J.C. D’Arcy.

The tourniquet in total knee arthroplasty. A prospective randomised study.

J Bone Joint Surg Br, 81B (1999), pp. 30-33

[8.]

R. Mencia-Barrio, S. Sánchez-Herráez, J.A. Alonso-Barrio, J. Sánchez-Lázaro, J.C. Betegón-Nicolás, O. Fernández-Hernández.

Eficacia de la hemostasia tras retirada del torniquete en la artroplastria de rodilla.

Rev Ortop Traumatol, 49 (2005), pp. 341-345

[9.]

Gutiérrez-Alamo J, Barco-Laakslo J, Ordóñez Parra M, Ortega Andreu. Isquemia y hemostasia en la artroplastia total de rodilla. Revista Digital de la Sociedad Española de la rodilla. serod@serod.org. 2000;12(9).

[10.]

M.J. Sanguesa Nebot, F. Cabanes Soriano, E. Villanueva Garcia, E. Fernández Sabaté.

Estudio comparativo de las pérdidas sanguíneas en cirugía protésica primaria de rodilla con diferentes pautas de drenaje.

Rev Ortop Traumatol, 75 (2004), pp. 160

[11.]

L.P. Jorn, A. Lindstrand, S. Toksvig-Larsen.

Tourniquet release increase bleeding. A randomized study of 77 knee repalcements.

Acta Orthop Scand, 70 (1999), pp. 265-270

Medline

[12.]

J. Widman, J. Isacson.

Surgical hemostasis after tourniquet release does not reduce blood loss in knee replacement. A prospective randomized study of 81 patients.

Acta Orthop Scand, 70 (1999), pp. 268-270

Medline

[13.]

M.A. Hersekli, S. Akpinare, G. Ozkoc, M. Ozalay, M. Uysal, N. Cesur, et al.

The timing of tourniquet release and its influence on blood loss after total knee arthroplasty.

Int Orthop, 28 (2004), pp. 138-141

http://dx.doi.org/10.1007/s00264-004-0550-5 | Medline

[14.]

B.C. Burkart, R.B. Bourne, C.H. Rorabeck, P.G. Kirk, L. Nott.

The efficacy of tourniquet release in blood conservation after total knee artrhoplasty.

Clin Orthop, 299 (1994), pp. 147-152

Medline

[15.]

Garriga Santamaría M, Fernández JJ, Cardona JM, Saló JC, Más J, Dealbert A. Sangrado Postquirúrgico en la artroplastia total de rodilla según el uso de manguito de isquemia arterial. Comunicación Oral 24 Congreso SEROD. Andorra. Mayo de 2005.

[16.]

J. Barwell, G. Anderson, A. Hasssan, I. Rawling, N.J. Barwell.

The effects of early tourniquet release during total knee arthroplasty: a prospective randomized double –blind study.

J Bone Joint Surg Br, 79 (1997), pp. 265-268

Medline

[17.]

J.G. Wright, M.C. Gebhardt.

Multicenter clinical trials in Orthopaedics: time for muskuloskeletal specialty societies to take action.

J Bone Joint Surg Am, 87A (2005), pp. 214-217

[18.]

E.C. Huskisson.

Measurement of pain.

Lancet, 304 (1974), pp. 1127-1131

[19.]

A.G. Christodoulou, A.L. Ploumis, I.P. Terzidis, P. Chantzidis, S.R. Metsovitis, D.G. Nikiforos.

The role of timing of tourniquet release and cementing on perioperative blood loss in total knee replacement.

Knee, 11 (2004), pp. 313-317

http://dx.doi.org/10.1016/j.knee.2003.09.005 | Medline

[20.]

A.G. Mylod Jr., M.P. France, D.E. Muser, J.R. Parson.

Perioperative blood loss associated with total knee arthroplasty. A comparison of procedures performed with and without cementing.

J Bone Joint Surg Am, 72 (1990), pp. 1010-1012

Medline

[21.]

A. Claus, G. Ashe, J. Brade, M. Bosing-Schwenkglenks, H. Horchler, J. Muller-Farber, et al.

Risk profiling of postoperative complications in 17.644 total knee replacements.

Unfallchirurg, 109 (2006), pp. 5-12

http://dx.doi.org/10.1007/s00113-005-0992-2 | Medline

[22.]

N. Prasad, V. Padmanabhan, A. Mullaji.

Blood loss in total knee arthroplasty: an analysis of risk factors.

Inter Orthop, 31 (2007), pp. 39-44

[23.]

P.M. Faris, M.A. Ritter, E.M. Keating, C.R. Valeri.

Unawashed filtered shed blood collected after knee and hip arthroplasties.

J Bone Joint Surg Am, 73A (1991), pp. 1169-1178

[24.]

J.H. Newman, M. Bowers, J. Murphy.

The clinical advantages of autologous transfusion. A randomised controlled study after knee replacement.

J Bone Joint Surg Br, 79B (1997), pp. 630-632

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