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

Información del artículo

Resumen

Bibliografía

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Estadísticas

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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