International Orthopaedics

, Volume 32, Issue 5, pp 635–638 | Cite as

Release of ischaemia prior to wound closure in total knee arthroplasty: a better method?

  • D. M. Hernández-Castaños
  • V. V. Ponce
  • F. Gil
Original Paper

Abstract

We included 46 total knee arthroplasties (43 patients) in a prospective, randomised study, dividing them into two groups: group A (23 knees, 21 patients) in which the ischaemia was released prior to wound closure allowing control of bleeding and group B (23 knees, 22 patients) releasing the tourniquet after suturing and bandaging. We compared the haemoglobin before surgery and at 24 and 48 h postoperatively, the total blood loss and the transfusions that were needed. Student's t-test was used to analyse the data. The results we obtained were as follows: preoperative haemoglobin in group A was 14.21 g/dl and group B 14.28 g/dl; haemoglobin at 24/48 h for group A was 10.04/10.1 g/dl and group B 10.28/10.3 g/dl; total blood loss was 743.2 cc for group A and 692.5 cc for group B; the mean number of blood units transfused were 2 in group A and 1.8 in group B. No statistical differences were found in the data analysed, but one of the complications in group B was major blood loss right after surgery that needed reintervention. We assume that this could have been avoided if the tourniquet had been released beforehand. We conclude that releasing ischaemia prior to wound closure does not demonstrate a statistical difference, but like other authors, we found clinical advantages suggesting the need of further study of this situation.

Résumé

Nous avons inclus 46 prothèses totales du genou (43 patients) dans une étude prospective randomisée avec deux groupes de patients. Un premier groupe : groupe A, 23 genoux, 21 patients avec lâchage du garrot avant la fermeture avec contrôle du saignement et un groupe B, 23 genoux, 22 patients, avec lâchage du garrot après la suture et le pansement. Ont été comparés le taux d’hémoglobine préopératoire à 24 et 48 heures postopératoires, les pertes totales sanguines et la nécessité de transfusion. Les résultats obtenus ont été les suivants. En préopératoire dans le groupe A, le taux d’hémoglobine était à 14.21 g/dl et dans le groupe B de 14.28 g/dl ; l’hémoglobine à 24/48 heures pour le groupe A était à 10.04 et 10.01 g/dl respectivement et dans le groupe B 10.28 et 10.3 g/dl respectivement ; les pertes sanguines étaient de 743.2 cc pour le groupe A et de 692.5 cc pour le groupe B et le nombre d’unités transfusées était de 2 dans le groupe A et de 1.8 dans le groupe B. Il n’y a pas de différences significatives entre les deux séries, en dehors d’une complication dans le groupe B, un saignement majeur nécessitant une réintervention. Nous pouvons avoir l’assurance que cette complication aurait été évitée si le garrot avait été levé avant la fermeture. Nous pouvons conclure que le relâchement du garrot après la fermeture ne permet pas d’avoir une différence significative entre les deux séries, néanmoins, nous pensons, ainsi que d’autres auteurs, qu’il est plus avantageux sur le plan clinique de relâcher le garrot avant la fermeture.

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • D. M. Hernández-Castaños
    • 1
    • 2
  • V. V. Ponce
    • 1
  • F. Gil
    • 1
  1. 1.Orthopaedic and Trauma DepartmentHospital Español de MéxicoMexico CityMexico
  2. 2.Mexico CityMexico

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