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: It is still controversial on the optimal timing of tourniquet used in total knee arthroplasty (TKA). Most previous studies focused on the comparison of different tourniquet application in controversial TKA, while the aim of our work was to compare three strategies of tourniquet application in minimally invasive TKA. 90 patients were enrolled in this study. Based on the different tourniquet application strategies, they were divided into three groups. Group A: using tourniquet during the whole surgery; Group B: tourniquet inflated before incision and deflated after the hardening of the cement; Group C: using tourniquet during the cementation. Blood loss and serum levels of C-reactive protein, IL-6, creatine kinase and myoglobin were checked preoperatively. The HSS knee score, VAS pain score, range of motion (ROM), limb swelling and hospital stays were also recorded. The mean levels of Hb and Hct were lower in Group C (104.2 ± 10.4 g/L, 31.8 ± 3.2 %) than those in Groups A (111.4 ± 14.4 g/L, p = 0.035; 34.1 ± 4.1 %, p = 0.032) and B (112.8 ± 14.3 g/L, p = 0.013; 34.5 ± 3.7 %, p = 0.011) immediately after the surgery. Compared with Groups A and B, both serum inflammation and muscle damage markers were lower in Group C. There were no significant differences between the groups in terms of HSS knee score, ROM, estimated blood loss, swelling ratio, VAS pain score and hospital stays. Using a tourniquet full time in minimally invasive TKA causes less intraoperative blood loss and more excessive inflammation and muscle damage. However, the advantage of part-time using tourniquet did not show in early functional outcomes.
    Archives of Orthopaedic and Trauma Surgery 02/2014; 134(4). DOI:10.1007/s00402-014-1948-1 · 1.36 Impact Factor
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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.
    The Journal of Arthroplasty 01/2014; DOI:10.1016/j.arth.2014.07.034 · 2.37 Impact Factor
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    ABSTRACT: Background The aim of this study is to evaluate the effects of tourniquet release before wound closure for hemostasis or after wound closure in cemented total knee arthroplasty (TKA).Methods We conducted a meta-analysis and review work on relevant clinical outcomes to evaluate the effects of the timing of tourniquet release in cemented TKA. Electronic databases were searched for relevant randomized controlled trials (RCTs) that compared outcomes of tourniquet release before wound closure for hemostasis with tourniquet release after wound closure. The methodological quality of each included RCT was assessed in terms of the 12-item scale. The meta-analysis was performed with STATA 12.0 software.ResultsEleven RCTs involving 651 patients with 670 TKAs were included in this meta-analysis. Of these, 332 patients (342 knees) were in an early tourniquet release group and 319 patients (328 knees) in the late tourniquet release group. The results showed that there were no significant differences in overt blood loss, hemoglobin drop, and blood transfusions, whereas the tourniquet release after wound closure might increase the risks of overall complications and major complications.Conclusions Tourniquet release before wound closure for hemostasis might reduce the rate of complications, but it could not limit overall blood loss. The current evidences are not enough to indicate that tourniquet release before wound closure is superior to its release after wound closure in cemented TKA.
    Journal of Orthopaedic Surgery and Research 12/2014; 9(1):125. DOI:10.1186/s13018-014-0125-0 · 1.58 Impact Factor