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Tourniquet application does not affect the periprosthetic bone cement penetration in total knee arthroplasty

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Poor scientific evidence exists on the issue of tourniquet application during total knee arthroplasty (TKA). It has been suggested that tourniquet application might improve interdigitation of the cement into the periprosthetic bones due to relatively dry surgical field. The hypothesis of the present study was that tourniquet use did not affect the periprosthetic bone cement penetration.

Methods

The single-centre, randomized, controlled trial included 86 patients undergoing primary TKA (Clinical-Trials.gov NCT02475603). All patients meeting the inclusion criteria were randomly assigned to the tourniquet (n = 43) or non-tourniquet (n = 43) group after obtaining a written informed consent. The cumulative bone cement penetration was radiologically measured in AP (seven zones) and lateral views (three zones) as defined by Knee Society Scoring System. Further parameters such as perioperative blood loss, soft tissue swelling, pain level/analgesic consumption, operative time, length of hospital stay (LOS) and complication rate were statistically compared between the groups.

Results

The cumulative bone cement penetration averaged 28.5 ± 1.7 mm in tourniquet versus 26.6 ± 1.6 mm in non-tourniquet groups (n.s.). The mean intraoperative blood loss was 250 ml higher in the non-tourniquet group (p = 0.0001). Patient-reported pre- to 6th-day post-operative reduction of the pain level was significantly higher in the non-tourniquet group (p = 0.003). The Morphine Equivalent Dose was higher in the Tourniquet group at discharge day (p = 0.02). Parameters such as total blood loss, soft tissue swelling, surgical time, LOS, and complication rates revealed similar results between the groups.

Conclusions

Tourniquet application did not influence the bone cement penetration significantly. Even though the intraoperative blood loss was reduced, the total blood loss was not affected significantly by tourniquet use. There was a tendency of higher post-operative pain and opioid analgesic requirement in the tourniquet group.

Level of evidence

I.

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Acknowledgements

We thank Dr. Faraj Bara for his contributions to the study design and preparation of the application forms for the Research Ethics Board. We thank our staff of the management office for the randomisation of the patients.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedics and Trauma Surgery, University Medical Center Mannheim of University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Ahmed Jawhar, Vera Stetzelberger, Karl Kollowa & Udo Obertacke

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  1. Ahmed Jawhar
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  2. Vera Stetzelberger
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  3. Karl Kollowa
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  4. Udo Obertacke
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Correspondence to Ahmed Jawhar.

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Conflict of interest

The authors declare that there were no conflicts of interest.

Ethical approval

The present study was approved by our Institutional Ethics Committee (File reference 2012-334N-MA) and was carried out in accordance with the Declaration of Helsinki.

Informed consent

Researchers approached the patients on admission day and written consent was obtained.

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Jawhar, A., Stetzelberger, V., Kollowa, K. et al. Tourniquet application does not affect the periprosthetic bone cement penetration in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 27, 2071–2081 (2019). https://doi.org/10.1007/s00167-018-5330-7

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  • DOI: https://doi.org/10.1007/s00167-018-5330-7

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