A poll was conducted at the 2009 Annual Meeting of the American Association of Hip and Knee Surgeons to determine current practices among its members in primary total hip arthroplasty and total knee arthroplasty. This article summarizes the audience responses to a number of multiple choice questions concerning perioperative management and operative practice patterns and preferences including anesthetic choices, blood management, surgical approaches, implant selection, implant fixation, bearing surface choice, postoperative rehabilitation, recommended postoperative activity restrictions, and antibiotic prophylaxis.
"Total knee arthroplasty (TKA) is commonly performed using a tourniquet. A recent survey reported that 95% of the members of the American Association of Hip and Knee surgeons used a tourniquet for TKA
. Most orthopedic surgeons believed that extensive soft tissue release and bone cuts could result in higher blood loss in TKA. "
[Show abstract][Hide abstract] ABSTRACT: The purpose of this research is to evaluate the effects of a tourniquet in total knee arthroplasty (TKA).
The study was done by randomized controlled trials (RCTs) on the effects of a tourniquet in TKA. All related articles which were published up to June 2013 from Medline, Embase, and Cochrane Central Register of Controlled Trails were identified. The methodological quality of the included studies was assessed by the Physiotherapy Evidence Database (PEDro) scale. The meta-analysis was performed using Cochrane RevMan software version 5.1.
Thirteen RCTs that involved a total of 689 patients with 689 knees were included in the meta-analysis, which were divided into two groups. The tourniquet group included 351 knees and the non-tourniquet group included 338 knees. The meta-analysis showed that using a tourniquet in TKA could reduce intraoperative blood loss (weighted mean difference (WMD), -198.21; 95% confidence interval (CI), -279.82 to -116.60; P < 0.01) but did not decrease the calculated blood loss (P = 0.80), which indicates the actual blood loss. Although TKA with a tourniquet could save the operation time for 4.57 min compared to TKA without a tourniquet (WMD, -4.57; 95% CI, -7.59 to -1.56; P < 0.01), it had no clinical significance. Meanwhile, the use of tourniquet could not reduce the possibility of blood transfusion (P > 0.05). Postoperative knee range of motion (ROM) in tourniquet group was 10.41[degree sign] less than that in the non-tourniquet group in early stage (<=10 days after surgery) (WMD, -10.41; 95% CI, -16.41 to -4.41; P < 0.01). Moreover, the use of a tourniquet increased the risk of either thrombotic events (risk ratio (RR), 5.00; 95% CI, 1.31 to 19.10; P = 0.02) or non-thrombotic complications (RR, 2.03; 95% CI, 1.12 to 3.67; P = 0.02).
TKA without a tourniquet was superior to TKA with a tourniquet in thromboembolic events and the other related complications. There were no significant differences between the two groups in the actual blood loss. TKA with a tourniquet might hinder patients' early postoperative rehabilitation exercises.
Journal of Orthopaedic Surgery and Research 03/2014; 9(1):13. DOI:10.1186/1749-799X-9-13 · 1.39 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The major benefit of TKA with tourniquet is operating in a bloodless field. A possible secondary benefit is a better cement bone interface for fixation. The disadvantages of tourniquet use for TKA include multiple risk factors both local and systemic including: nerve damage, altered hemodynamics with limb exsanguinations and reactive hyperemia with tourniquet release, delay in recovery of muscle or nerve function, increased risk of DVT with direct trauma to vessel walls and increased levels of thrombin-antithrombin complexes. A greater risk for large venous emboli propagation and transesophageal echogenic particles, vascular injury with higher risk in atherosclerotic, calcified arteries, and an increase in wound healing disturbances. Our initial experience with TKA without tourniquet was in high risk patients with previous DVT or PE, multiple scarring, or compromised cardiovascular status. We have used this method on all patients for the last eight years. The protocol includes regional anesthesia, incision and approach made with 90 degree knee flexion, meticulous hemostasis, jet lavage and filtered carbon dioxide delivered to dry and prepare bone beds for cementation and routine closure. We have encountered no differences in blood loss or transfusion rates, less post-op pain, faster straight leg raise and knee flexion gains, and fewer wound healing disturbances. We recommend TKA without tourniquet.
Seminars in Arthroplasty 09/2011; 22(3):176-178. DOI:10.1053/j.sart.2011.07.010
[Show abstract][Hide abstract] ABSTRACT: The number of total hip replacement (THR) surgeries has increased significantly over the last few years and patients undergoing surgery are of decreasing age. In consequence the question of the influencing factors for the survival of artificial hip joints becomes more and more urgent. The expected survival time of an implant is nowadays 15-20 years and it seems that factors for a shorter lifetime are female gender, overweight, younger age and certain indications which led to surgery, such as rheumatoid arthritis or fractures. In the early phase of rehabilitation, measures against dislocation including training of the abductor muscles are most important. Starting rehabilitation programs early after surgery has positive effects on outcome, especially when strengthening programs are included. There are different opinions concerning the question how the lifetime of a THR is influenced by sports activities. However, it seems to have been demonstrated that suitable sports activities have a positive effect and do not necessarily correlate with higher loosening rates after THR. In general, high-impact sports should be avoided. Recommended activities are cycling, swimming, aquajogging, hiking, rowing and dancing.
Der Orthopäde 06/2011; 40(6):513-9. DOI:10.1007/s00132-011-1761-2 · 0.36 Impact Factor
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