J Korean Orthop Assoc.  2013 Feb;48(1):16-21. 10.4055/jkoa.2013.48.1.16.

The Effects of Timing of Tourniquet Release on Blood Loss in Navigation Assisted Total Knee Arthroplasty

• Kim KK
• Won YY
• Oh HT
• Lee DH

• KMID: 2106658
• DOI: http://doi.org/10.4055/jkoa.2013.48.1.16

Abstract

PURPOSE
The aim of this study is to evaluate the effects of timing of tourniquet release on blood loss in navigation assisted total knee arthroplasty.
MATERIALS AND METHODS
A total of 63 consecutive patients, who underwent navigation assisted total knee arthroplasty, were divided into two groups; 31 patients (31 knees, group I) were operated with tourniquet release after wound closure and applied compression dressing, and another 32 patients (32 knees, group II) were operated with tourniquet release and hemostasis before implantation of the polyethylene insert. We examined hemoglobin concentration and hematocrit at three points in time, preoperatively, 24 hours and 48 hours postoperatively. We compared the two groups of patients in terms of total blood loss, postoperative drained blood loss, hidden blood loss, visible blood loss and operation time.
RESULTS
There were no significant differences between the two groups in the hemoglobin concentration at 24 hours and 48 hours postoperatively (p=0.371, p=0.247), and hematocrit at 24 hours and 48 hours postoperatively (p=0.428, p=0.125). No statistically significant differences between the two groups in the postoperative drained blood loss (p=0.381) and total blood loss (p=0.126) were found. We found statistically significant differences in the visible blood loss (p=0.023), hidden blood loss (p=0.045) and operation time (p=0.005).
CONCLUSION
The releasing time of tourniquet have no effect on the actual total blood loss, and postoperative drained blood loss in navigation assisted total knee arthroplasty. We concluded that compared with intraoperative tourniquet release, postoperative tourniquet release are useful for making the broader operation field and less operation time.

Keyword

knee; navigation; arthroplasty; tourniquets; blood loss

MeSH Terms

Arthroplasty
Bandages
Hematocrit
Hemoglobins
Hemostasis
Humans
Knee
Polyethylene
Postoperative Hemorrhage
Tourniquets
Hemoglobins
Polyethylene

Reference

1. Sehat KR, Evans RL, Newman JH. Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss into account. J Bone Joint Surg Br. 2004. 86:561–565.

2. Abdel-Salam A, Eyres KS. Effects of tourniquet during total knee arthroplasty. a prospective randomised study. J Bone Joint Surg Br. 1995. 77:250–253.

3. Parmet JL, Horrow JC, Berman AT, Miller F, Pharo G, Collins L. The incidence of large venous emboli during total knee arthroplasty without pneumatic tourniquet use. Anesth Analg. 1998. 87:439–444.

4. Clarke MT, Longstaff L, Edwards D, Rushton N. Tourniquet-induced wound hypoxia after total knee replacement. J Bone Joint Surg Br. 2001. 83:40–44.

5. Yavarikia A, Amjad GG, Davoudpour K. The influence of tourniquet use and timing of its release on blood loss in total knee arthroplasty. Pak J Biol Sci. 2010. 13:249–252.

6. Lotke PA, Faralli VJ, Orenstein EM, Ecker ML. Blood loss after total knee replacement. Effects of tourniquet release and continuous passive motion. J Bone Joint Surg Am. 1991. 73:1037–1040.

7. Kalairajah Y, Simpson D, Cossey AJ, Verrall GM, Spriggins AJ. Blood loss after total knee replacement: effects of computer-assisted surgery. J Bone Joint Surg Br. 2005. 87:1480–1482.

8. Ajwani SH, Jones M, Jarratt JW, Shepard GJ, Ryan WG. Computer assisted versus conventional total knee replacement: a comparison of tourniquet time, blood loss and length of stay. Knee. 2012. 19:606–610.

9. Weng YJ, Hsu RW, Hsu WH. Comparison of computer-assisted navigation and conventional instrumentation for bilateral total knee arthroplasty. J Arthroplasty. 2009. 24:668–673.

10. Kutty S, McElwain JP. Padding under tourniquets in tourniquet controlled surgery: Bruner's ten rules revisited. Injury. 2002. 33:75.

11. Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology. 1983. 58:277–280.

12. Zhang FJ, Xiao Y, Liu YB, Tian X, Gao ZG. Clinical effects of applying a tourniquet in total knee arthroplasty on blood loss. Chin Med J (Engl). 2010. 123:3030–3033.

13. Tetro AM, Rudan JF. The effects of a pneumatic tourniquet on blood loss in total knee arthroplasty. Can J Surg. 2001. 44:33–38.

14. 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. 33:1263–1268.

15. Barwell J, Anderson G, Hassan A, Rawlings I. The effects of early tourniquet release during total knee arthroplasty: a prospective randomized double-blind study. J Bone Joint Surg Br. 1997. 79:265–268.

16. Christodoulou AG, Ploumis AL, Terzidis IP, Chantzidis P, Metsovitis SR, Nikiforos DG. The role of timing of tourniquet release and cementing on perioperative blood loss in total knee replacement. Knee. 2004. 11:313–317.

17. Ward CF, Meathe EA, Benumof JL, Trousdale F. A computer nomogram for blood loss replacement. Anesthesiology. 1980. 53:S126.

18. Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery. 1962. 51:224–232.

19. Erskine JG, Fraser C, Simpson R, Protheroe K, Walker ID. Blood loss with knee joint replacement. J R Coll Surg Edinb. 1981. 26:295–297.

20. McManus KT, Velchik MG, Alavi A, Lotke PA. Noninvasive assessment of postoperative bleeding in TKA patients with Tc-99m RNCs. J Nucl Med. 1987. 28:565–567.

21. Pattison E, Protheroe K, Pringle RM, Kennedy AC, Dick WC. Reduction in haemoglobin after knee joint surgery. Ann Rheum Dis. 1973. 32:582–584.

22. Authier B. Reactive hyperemia monitored on rat muscle using perfluorocarbons and 19F NMR. Magn Reson Med. 1988. 8:80–83.

23. Klenerman L, Chakrabarti R, Mackie I, Brozovic M, Stirling Y. Changes in haemostatic system after application of a tourniquet. Lancet. 1977. 1:970–972.

24. Silver R, de la Garza J, Rang M, Koreska J. Limb swelling after release of a tourniquet. Clin Orthop Relat Res. 1986. 206:86–89.

25. Petäjä J, Myllynen P, Myllylä G, Vahtera E. Fibrinolysis after application of a pneumatic tourniquet. Acta Chir Scand. 1987. 153:647–651.

26. Murphy CG, Winter DC, Bouchier-Hayes DJ. Tourniquet injuries: pathogenesis and modalities for attenuation. Acta Orthop Belg. 2005. 71:635–645.

27. Nakahara M, Sakahashi H. Effect of application of a tourniquet on bleeding factors in dogs. J Bone Joint Surg Am. 1967. 49:1345–1351.

28. Wittmann FW, Ring PA. Blood loss associated with Ring uncemented total knee replacement: comparison between continuous and intermittent suction drainage. J R Soc Med. 1984. 77:556–558.

29. Peersman G, Laskin R, Davis J, Peterson MG, Richart T. Prolonged operative time correlates with increased infection rate after total knee arthroplasty. HSS J. 2006. 2:70–72.