Article

Timing of tourniquet release in total knee arthroplasty when using a postoperative blood salvage drain.

Department of Orthopedic Surgery, Palo Alto Health Care Stystem, Palo Alto, California 94304, USA.
The Journal of arthroplasty (Impact Factor: 2.37). 05/2008; 24(4):539-42. DOI: 10.1016/j.arth.2008.01.302
Source: PubMed

ABSTRACT The purpose of this study is to examine the effect of a postoperative blood salvage drain and timing of tourniquet release on the maximal hematocrit drop after total knee arthroplasty. Thirty-seven total knees were prospectively randomized into either an early or late tourniquet release group. Hematocrit drop and drainage amounts were recorded. We found no significant difference in maximal hematocrit drop, drainage amounts, or total surgical time between the groups. We conclude that the use of a blood salvage drain should not influence the surgeon's preference on timing of tourniquet release in total knee arthroplasty.

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    ABSTRACT: The purpose of this study is to examine our hypothesis that releasing tourniquet intraoperatively before wound closure is better than releasing postoperatively after wound closure and bandaging. We carried out a systematic review using meta-analysis of selected randomized controlled trials comparing tourniquet releasing before and after wound closure in TKA. The results showed that tourniquet releasing before wound closure significantly increased the total blood loss (p < 0.00001), calculated blood loss (p < 0.0001) as well as postoperative blood loss (p = 0.007). However, it decreased the risk of both minor (p = 0.0007) and major complications (p = 0.05).The available evidence indicated that releasing tourniquet before wound closure for hemostasis increased perioperative blood loss. Nevertheless, the risk of complications decreased significantly when the tourniquet was released before wound closure.
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