Key result
Early tourniquet use in TKA cuts intraoperative bleeding ~32% but worsens total blood loss and pain.
Why the study?
The study was conducted to compare the effects of different tourniquet application methods during TKA in patients with hypertension and determine the best technique.
Does the timing of tourniquet application affect blood loss, pain, and rehabilitation in patients with hypertension undergoing TKA?
RCT (n=100)
Randomized into three groups
Yes
Does the timing of tourniquet application affect blood loss, pain, and rehabilitation in patients with hypertension undergoing TKA?
Absolute Event Rate: 239.26% vs 353.72%
p-value: p=0.025
Using a tourniquet before placing the cement knee prosthesis and loosening it after suturing and pressure bandaging improves blood loss and short-term functional outcomes in hypertensive patients undergoing TKA.
Shorter tourniquet use cuts early complications and improves recovery in hypertensive TKA patients; extends timing optimization data from prior RCTs.
Purpose: The primary aim was to compare the effects of different tourniquet application methods during the TKA surgery of patients with hypertension and determine the best technique of using a tourniquet.Methods: A total of 100 patients were divided into three groups. Patients in group A who underwent TKA with tourniquet using before skin incision, and released after the skin was closed, and patients in group B with tourniquet using before the knee prosthesis was placed, and leased after the skin was closed. Patients in group C with tourniquet use before placing knee prosthesis, the tourniquet was leased after bone cement solidified. The following medical outcomes of the three groups were monitored and recorded: the operation time, intraoperative blood loss volume, postoperative complication, the amount of hidden blood loss, total blood loss, blood transfusion, swelling rate, visual analogue scale (VAS) and the knee society score (KSS).Results: The intraoperative blood loss in Group A was significantly low than that in Group B and Group C(P<0.05). In terms of hidden blood loss, total blood loss and blood transfusion, the difference among the three groups was statistically significant which Group A was higher than group B and group C(P< 0.05); No significant differences were observed between Group A, Group B and Group C when we compared operation time. The swelling rate and VAS score in group A 3 days after operation was significantly higher than that of group B and group C (P<0.05); KSS score three weeks after operation in group A were significantly lower than those in group B and group C(P<0.05). There was no significant difference in KSS scores between the three groups one year after operation (P > 0.05). Conclusion: Tourniquets could be used before placing the cement knee prosthesis, and loosened after the suture is completed and the pressure bandage is applied, which can obviously improve the intraoperative blood loss and the short-term postoperative functional effect of the patient, with fewer postoperative complications, but the long-term clinical effect needs further observation.
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Guo et al. (2022) conducted an RCT in Knee osteoarthritis with hypertension (n=100). Tourniquet application timing vs. Different timing groups (Group A, B, C) was evaluated on Intraoperative blood loss (ml) (p=0.025). Applying a tourniquet before skin incision and releasing it after skin closure significantly reduced intraoperative blood loss to 239.26 ml compared to later application methods, but increased total blood loss and postoperative pain in hypertensive patients undergoing TKA.
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