A Randomized Controlled Study on the Use of Tourniquet in Primary Total Knee Arthroplasty

Effects of special waterproof layer under tourniquet cuff on the incidence of burns and pain intensity and satisfaction of operating room staff in knee arthroscopic surgeries: a randomized clinical trial

INTRODUCTION

The use of multiple layers of vibril under tourniquet cuffs is common. However, these layers can lead to complications. We designed a special waterproof curtain for use under tourniquet cuffs. Its effects on burns, postoperative pain, and operating room staff satisfaction were evaluated.

MATERIALS & METHODS

In this randomized clinical trial, 34 patients underwent arthroscopic surgery of the knee joint in the operating rooms of selected hospitals at Isfahan University of Medical Sciences in 2022 via a simple random method. Even and odd days were divided into two groups: Group A (even days: special tourniquet drape: 17 people) and Group B (odd days: usual layers under the pneumatic tourniquet cuff: 17 people). The degree of pain was evaluated with a visual analog scale (VAS), the severity of burns was evaluated on the basis of a rating from one to four, and the satisfaction of the operating room personnel was evaluated via a standardized questionnaire with 10 questions.

RESULTS

Pain intensity was lower in Group A than in Group B at all times: immediately after recovery (2.29 ± 0.47 vs. 5.00 ± 0.71, P < 0.001), during the first eight hours (1.71 ± 0.47 vs. 3.94 ± 0.56, P < 0.001), during the second eight hours (2.82 ± 0.73 vs. 5.12 ± 0.45, P < 0.001), and during the third eight hours (1.65 ± 0.61 vs. 3.59 ± 0.62, P < 0.001). None of the participants in Group A and only one participant (5.9%) in Group B suffered burns, a difference that was not significant (P = 0.5). Most of operating room personnel (82.4%) reported a "high" level of satisfaction.

CONCLUSION

The use of a special tourniquet in arthroscopic surgeries of the knee joint seems to have a positive effect, considering the reduction in postoperative pain and the increase in the level of satisfaction of the operating room personnel.

Does the Use of a Tourniquet Influence Five-Year Outcomes Following Total Knee Arthroplasty?

BACKGROUND

A tourniquet is commonly used during total knee arthroplasty (TKA) to improve surgical field visibility and minimize blood loss. While the short-term effects of tourniquet use on postoperative outcomes have been studied extensively and found to be minimal, its influence on longer-term outcomes remains underexplored. This study examined tourniquet use in TKA with up to 5-year follow-up.

METHODS

In this post hoc analysis of a randomized controlled trial, 227 patients who underwent primary TKA in the tourniquet (T) group (n = 112) or no tourniquet (NT) group (n = 115) were evaluated. Clinical outcomes and patient-reported outcome measures were compared between the two groups.

RESULTS

The T group had non-significant trends toward reduced blood loss (131.8 versus 116.7 mL, P = 0.098) and shorter operative time (97.8 versus 95.7 minutes, P = 0.264), with slightly higher postoperative day one visual analog scale pain scores (3.1 versus 3.6, P = 0.197). Length of stay (2.0 versus 2.1 days, P = 0.837) and home discharge rate (88.7 versus 92.0%, P = 0.340) were comparable. The NT group had 3 90-day readmissions, while none occurred in the T group (2.7 versus 0%, P = 0.081). The active range of motion at the final follow-up was similar between groups (108.3 versus 106.5 degrees, P = 0.457). All-cause revision rates at 5 years were comparable between the NT and T groups (5.2 versus 3.6%, P = 0.546). Kaplan-Meier survivorship analysis revealed comparable aseptic implant survival at 5 years (P = 0.769). There were no significant differences in Knee injury and Osteoarthritis Outcome Score for Joint Replacement, Patient-Reported Outcomes Measurement Information System (PROMIS) pain intensity, PROMIS pain interference, or PROMIS physical health scores at 3 months, 1 year, and 5 years postoperatively.

CONCLUSIONS

Using a tourniquet during primary TKA was not associated with differences in clinical or patient-reported outcomes at up to 5-year follow-up. These findings suggest that tourniquet use in TKA can be left to the surgeon's discretion.

LEVEL OF EVIDENCE

III.

Tourniquet Effect on Patients Undergoing Total Knee Arthroplasty: A Single-Blind, Randomized Controlled Trial

BACKGROUND

Tourniquet is applied in Total Knee Arthroplasty (TKA) to reduce intraoperative blood loss and improve view of surgical field. However, tourniquet use in TKA is still in dispute. Some researchers find that tourniquet may lead to extra side effects such as aggravated pain and limb swelling, while others consider that tourniquet has no significant adverse impact on clinical outcomes of TKA patients. This trial is conducted to evaluate tourniquet effect on TKA patients.

METHODS

A prospective, single-blind, randomized controlled trail is adopted with a sample size of 130 knees from August 2020 to February 2023. Patients undergoing TKA are randomly allocated to tourniquet group and non-tourniquet group. Outcomes including quadriceps thickness and stiffness, operation time, total blood loss, intraoperative blood loss, postoperative blood loss, transfusion rate, thigh circumference, knee and thigh VAS, D-Dimer and CRP level, knee function score, patient satisfaction, and complications are evaluated in this trial. Student's t-test, Mann-Whitney U test, Pearson's chi-square test, and Fisher's exact test are used in this study.

RESULTS

No significant difference in demographic information and baseline outcomes were found (p > 0.05). Participants in the tourniquet group had significantly less total blood loss and intraoperative blood loss, more postoperative blood loss, and higher D-Dimer level on postoperative day 3 when compared with non-tourniquet group (p < 0.05). Other outcomes including quadriceps thickness and stiffness, operation time, postoperative blood loss, transfusion rate, thigh circumference, knee and thigh VAS, D-Dimer level on postoperative day 1, CRP level, knee function score, patient satisfaction, and complications showed no significant difference (p > 0.05).

CONCLUSION

Tourniquet application can effectively reduce intraoperative blood loss and total blood loss, without significant side effects. Hence, we advocate the regular use of tourniquet in primary TKA.

Image-Free Robotic-Assisted Total Knee Arthroplasty Results in Quicker Recovery but Equivalent One-Year Outcomes Compared to Conventional Total Knee Arthroplasty

BACKGROUND

Few studies have addressed whether robotic-assisted total knee arthroplasty (RA-TKA) significantly impacts functional outcomes. This study was conducted to determine whether image-free RA-TKA improves function compared to conventional total knee arthroplasty (C-TKA), performed without the utilization of robotics or navigation, using the Minimal Clinically Important Difference (MCID) and Patient Acceptable Symptom State (PASS) as measures of meaningful clinical improvement.

METHODS

A multicenter propensity score-matched retrospective study was conducted of RA-TKA using an image-free robotic system and C-TKA cases at an average follow-up of 14 months (range, 12 months to 20 months). Consecutive patients who underwent primary unilateral TKA and had a preoperative and postoperative Knee Injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR) were included. The primary outcomes were the MCID and PASS for KOOS-JR. 254 RA-TKA and 762 C-TKA patients were included, with no significant differences in sex, age, body mass index, or comorbidities.

RESULTS

Preoperative KOOS-JR scores were similar in the RA-TKA and C-TKA cohorts. Significantly greater improvement in KOOS-JR scores were achieved at 4 to 6 weeks postoperatively with RA-TKA compared to C-TKA. While the mean 1-year postoperative KOOS-JR was significantly higher in the RA-TKA cohort, no significant differences were found in the Delta KOOS-JR scores between the cohorts, when comparing preoperative and 1-year postoperative. No significant differences existed in the rates of MCID or PASS being achieved.

CONCLUSION

Image-free RA-TKA reduces pain and improves early functional recovery compared to C-TKA at 4 to 6 weeks, but functional outcomes at 1 year are equivalent based on the MCID and PASS for KOOS-JR.

Effectiveness of Neuromuscular Electrical Stimulation for Enhanced Recovery After Total Hip Replacement Surgery: A Randomized Controlled Trial

Background

The aim of this study was to investigate the feasibility of using a novel neuromuscular electrical stimulation (NMES) device for enhanced recovery after total hip replacement surgery.

Methods

Sixty patients undergoing total hip replacement for osteoarthritis of the hip were randomized and divided into 2 groups: 1 group received postoperative treatment with the NMES device, and the other group did not receive NMES. The primary outcome measures were postoperative pain, lower limb swelling, and length of stay (LOS) postsurgery. Secondary outcomes included wound drainage at 24 hours and acceptability by the intervention of the device.

Results

Data from 60 participants were analyzed (NMES (n = 30), control group (n = 30)). Patients in the NMES group demonstrated a general trend of beneficial postoperative pain, calf swelling, and average length of stay from postoperative to discharge. However, wound drainage largely remained static for both groups. The overall comfort rate of the device was 93.3%.

Conclusions

The results of this study suggest that the geko^TM NMES device is partly useful for enhanced recovery after total hip replacement surgery. In addition, the device should be considered tolerable and safe. A larger study is required with this device in the future to determine its effectiveness on compelling data.