Iranian Journal of Orthopedic Surgery

A Comparative study of perioperative bleeding of total knee arthroplasty and the need for blood transfusion with and without use of tourniquet

Authors

jafar Soleimanpoor
Siamak Kazemi sufi
Amin Moradi

Tabriz University of Medical Sciences

https://doi.org/10.22034/ijos.2020.121408
Abstract
Background:
Total knee arthroplasty (TKA) is one of the most common orthopedic surgeries in the world. The use of tourniquet is recommended by some surgeons around the world. However, the evidence of its usefulness in replacing the knee is still uncertain. In the present study, we assessed the effect of using tourniquet in reducing bleeding during and after operation and the amount of transfusion requirement in TKA surgery.
Methods and Materials:
Patients referred to Imam Reza and Tabriz universal hospitals for TKA surgery in case of absence of hemorrhagic diseases and non-use of anticoagulants were included in this study. In this study, 8 (25.8%) males and 23 (74.2%) females were present with an average age of 63.6 ± 7.86 with a minimum age of 52 years and a maximum age of 81 years. Patients' Randomization applied considering balanced mean age and body mass index (BMI). In the first group after the patient's preparation and induction of anesthesia, the tourniquet was considered and surgery was performed and the tourniquet was released immediately after the cement was inserted. In the second group after the patient's preparation and induction of anesthesia, tourniquet was not used until cementation and after that again deflated. All surgical procedures were performed by the same and experienced surgical team using spinal epidural anesthesia. The standard surgical procedure was considered by surgeons.
Results:
23 (74.2%) patients did not need blood transfusion, and 8 (25.8%) patients needed transfusion. The average duration of surgery was 75.81 ± 26.3 minutes with a minimum duration of 30 minutes and a maximum of 125 minutes. The mean preoperative HB level was 12.66 ± 1.67, which was 11.09 ± 1.62 after surgery.
Conclusion:
In conclusion, the use of tourniquet in patients undergoing TKA surgery reduces the duration of surgery but does not significantly affect hemoglobin maintenance after surgery. In other words, the use of tourniquet does not have an effect on reducing the need for blood transfusion.
 

Keywords

Total Knee Arthroplasty
Tourniquet
Hemoglobin
  1. Jones CA, Beaupre LA, Johnston D, Suarez-Almazor ME. Total joint arthroplasties: current concepts of patient outcomes after surgery. Rheum Dis Clin North Am. 2007;33(1):71-86.
  2. 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(5):499-503.
  3. Rai M, Mohapatra A, Radhesh, Bhandary B. Post-operative clinical outcomes in patients with or without the use of tourniquet in total knee replacement surgery. International Journal of Orthopaedics Sciences. 2017;3(4):201-3.

 

  1. Zhang W, Li N, Chen S, Tan Y, Al-Aidaros M, Chen L. The effects of a tourniquet used in total knee arthroplasty: a meta-analysis. J Orthop Surg Res. 2014;9(1):13.
  2. Zhou K, Ling T, Wang H, Zhou Z, Shen B, Yang J, et al. Influence of tourniquet use in primary total knee arthroplasty with drainage: a prospective randomised controlled trial. J Orthop Surg Res. 2017;12(1):172.
  3. Hernandez AJ, Almeida AM, Favaro E, Sguizzato GT. The influence of tourniquet use and operative time on the incidence of deep vein thrombosis in total knee arthroplasty. Clinics (Sao Paulo). 2012;67(9):1053-7.
  4. Berry DJ, Bozic KJ. Current practice patterns in primary hip and knee arthroplasty among members of the American Association of Hip and Knee Surgeons. J Arthroplasty. 2010;25(6):2-4.
  5. Rosenstein AD, Michelov YA, Thompson S, Kaye AD. Benefits of limited use of a tourniquet combined with intravenous tranexamic acid during total knee arthroplasty. Ochsner J. 2016;16(4):443-9.
  6. Tai TW, Lin CJ, Jou IM, Chang CW, Lai KA, Yang CY. Tourniquet use in total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2011;19(7):1121-30.
  7. Moráis S, Ortega-Andreu M, Rodríguez-Merchán C, Padilla-Eguiluz NG, Pérez-Chrzanowska H, Figueredo-Zalve R, et al. Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach. Int Orthop. 2014;38(2):347-54.
  8. Woolson ST, Wall WW. Autologous blood transfusion after total knee arthroplasty: a randomized, prospective study comparing predonated and postoperative salvage blood. J Arthroplasty. 2003;18(3):243-9.
  9. Nishiguchi M, Takamura N, Abe Y, Kono M, Shindo H, Aoyagi K. Pilot study on the use of tourniquet: a risk factor for pulmonary thromboembolism after total knee arthroplasty? Thromb Res. 2005;115(4):271-6.
  10. Vandenbussche E, Duranthon LD, Couturier M, Pidhorz L, Augereau B. The effect of tourniquet use in total knee arthroplasty. Int Orthop. 2002;26(5):306-9.
  11. Fukuda A, Hasegawa M, Kato K, Shi D, Sudo A, Uchida A. Effect of tourniquet application on deep vein thrombosis after total knee arthroplasty. Arch Orthop Trauma Surg. 2007;127(8):671-5.
  12. Aglietti P, Baldini A, Vena L, Abbate R, Fedi S, Falciani M. Effect of tourniquet use on activation of coagulation in total knee replacement. Clin Orthop Relat Res. 2000;371:169-77.
  13. Hsu K-L, Chang C-W, Yang C-Y, Wang J-H. Tourniquet Use in Total Knee Arthroplasty. In: Rozim Zorzi A, de Miranda JB, editors. Primary Total Knee Arthroplasty. London: IntechOpen Limited; 2018. p. 81.
  14. Katsumata S, Nagashima M, Kato K, Tachihara A, Wauke K, Saito S, et al. Changes in coagulation‐fibrinolysis marker and neutrophil elastase following the use of tourniquet during total knee arthroplasty and the influence of neutrophil elastase on thromboembolism. Acta Anaesthesiol Scand. 2005;49(4):510-6.
  15. Li B, Wen Y, Wu H, Qian Q, Lin X, Zhao H. The effect of tourniquet use on hidden blood loss in total knee arthroplasty. Int Orthop. 2009;33(5):1263-8.
  16. Tetro AM, Rudan JF. The effects of a pneumatic tourniquet on blood loss in total knee arthroplasty. Can J Surg. 2001;44(1):33-8.
  17. Alcelik I, Pollock RD, Sukeik M, Bettany-Saltikov J, Armstrong PM, Fismer P. A comparison of outcomes with and without a tourniquet in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Arthroplasty. 2012;27(3):331-40.
  18. Huang Z, Ma J, Zhu Y, Pei F, Yang J, ZHou Z, et al. Timing of tourniquet release in total knee arthroplasty. Orthopedics. 2015;38(7):445-51.
  19. Zan PF, Yang Y, Fu D, Yu X, Li GD. Releasing of tourniquet before wound closure or not in total knee arthroplasty: a meta-analysis of randomized controlled trials. J Arthroplasty. 2015;30(1):31-7.
  20. Tie K, Hu D, Qi Y, Wang H, Chen L. Effects of tourniquet release on total knee arthroplasty. Orthopedics. 2016;39(4):e642-50.
  21. Harvey E, Leclerc J, Brooks C, Burke D. Effect of tourniquet use on blood loss and incidence of deep vein thrombosis in total knee arthroplasty. J Arthroplasty. 1997;12(3):291-6.
  22. Tai T-W, Chang C-W, Lai K-A, Lin C-J, Yang C-Y. 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):2209-15.
  23. Cai D, Fan Q, Zhong H, Peng S, Song H. The effects of tourniquet use on blood loss in primary total knee arthroplasty for patients with osteoarthritis: a meta-analysis. J Orthop Surg Res. 2019;14(1):348.

 

Home

Submit Manuscript

Contact Us