Effect of tourniquet application on deep vein thrombosis after total knee arthroplasty.
ABSTRACT There is a great deal of controversy about the effect of tourniquets on development of deep vein thrombosis (DVT) after total knee arthroplasty (TKA).
We investigated the incidence of postoperative DVT after TKA with or without the use of a tourniquet. The patients were 48 consecutive patients undergoing primary ipsilateral cemented TKA for osteoarthritis. Group A (21 patients) underwent the operation without a tourniquet, and Group B (27 patients) underwent the operation with a tourniquet. Ultrasonography to assess DVT was performed before and after the operation.
Group B had less intraoperative and total blood loss than Group A. Postoperative DVT was detected in 81.3% of all cases, and symptomatic pulmonary embolism occurred in 1.7%. Most of DVT was found in the calf vein. There was no significant difference in the incidence of postoperative DVT between the two groups.
We conclude that the use of a tourniquet is beneficial, because it decreases perioperative blood loss and does not increase the risk of DVT. The incidence of DVT after TKA is considerably high with or without use of a tourniquet. Therefore, prevention and early detection of DVT are important for prevention of fatal pulmonary thromboembolism.
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ABSTRACT: The incidence of venous thromboembolism after elective knee surgery has previously been studied almost exclusively in patients receiving total knee replacements, in whom the risk of a deep vein thrombosis is approximately 60%. We report the results of ipsilateral ascending venography in 312 patients undergoing a wide variety of elective knee operations under tourniquet ischaemia, none of whom received any specific prophylaxis against thromboembolism. Total knee replacement was confirmed to carry a high risk with ipsilateral deep vein thrombosis in 56.4% and symptomatic pulmonary embolism in 1.9%. By contrast, arthroscopy was associated with a low incidence of venous thrombosis (4.2%). Meniscectomy, arthrotomy, patellectomy, synovectomy and arthrodesis were all high-risk procedures, particularly in patients over 40 years of age, and were associated with deep vein thrombosis rates of 25% to 67%. On the basis of these findings, we advise prophylaxis against venous thromboembolism in all patients over 40 years of age undergoing elective knee surgery other than arthroscopy.Journal of Bone and Joint Surgery - British Volume 06/1989; 71(3):492-7. · 2.69 Impact Factor
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ABSTRACT: We performed a prospective randomized clinical study to determine whether use of a thigh tourniquet influences the incidence of deep venous thrombosis. The lower limbs of patients who were scheduled for elective surgery on the fore part of the foot were randomized and assigned to one of three treatment categories: Group I, no tourniquet; Group II, exsanguination by an Esmarch bandage before tourniquet application; and Group III, exsanguination by elevation of the extremity prior to application of a tourniquet. The 117 limbs of seventy-one patients included in this study were evaluated preoperatively and twenty-four and seventy-two hours postoperatively with 125I-labeled fibrinogen, and preoperatively and seventy-two hours postoperatively with Doppler ultrasound studies and phleborheography. The findings in all of the Doppler ultrasound studies and all of the phleborheograms were normal. Two of the 125I-fibrinogen studies were positive, but subsequent contrast venography revealed that these were false-positive findings. We therefore concluded that the use of a thigh tourniquet does not increase the risk of deep venous thrombosis in patients who have had an operation on the fore part of the foot.The Journal of Bone and Joint Surgery 03/1982; 64(2):188-91. · 3.23 Impact Factor
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ABSTRACT: Despite prophylactic therapy, pulmonary embolism remains the leading cause of perioperative mortality in patients undergoing total knee arthroplasty (TKA). We used transoesophageal echocardiography to monitor 29 consecutive patients during TKA. Showers of substantial amounts of echogenic material, lasting for 3-15 min, were visible in the right atrium and ventricle within 10-15 s of tourniquet deflation in all patients. A 3 x 6 mm fresh thrombus was aspirated from the central circulation of one patient. Another patient, who had had a Greenfield filter placed for previous thromboembolism, showed very little echogenic material after tourniquet deflation. The composition and importance of these echogenic emboli remain uncertain.The Lancet 05/1993; 341(8852):1057-8. · 39.06 Impact Factor