Skip to main content
SpringerLink
Log in

Influence of the tourniquet on tibial cement mantle thickness in primary total knee arthroplasty

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

Abstract

Purpose

The purpose of the study was whether the use of a tourniquet increases cement mantle thickness in primary total knee arthroplasty and influences the calculated blood loss and postoperative pain.

Methods

Ninety patients with a primary total knee arthroplasty (TKA) were enroled in this prospective randomised trial and divided into a group with (n = 45) and without tourniquet (n = 45). The radiological tibial cement mantle thickness was evaluated postoperatively in four zones on anteroposterior and two zones on lateral radiographs, and values were cumulated. Additionally, the calculated blood loss and postoperative pain levels were recorded.

Results

There was a median cumulative cement mantle thickness of 13 mm (range 8–19 mm) without tourniquet and of 14.2 mm (range 9–18 mm) with tourniquet (p = 0.009). The median calculated blood loss was 0.6 L (range 0.2–2.0 L) without and 0.9 L (range 0.3–1.5 L) (p = 0.02) with tourniquet. Patient-reported postoperative pain levels were significantly higher in the tourniquet group during mobilisation (p = 0.01) and at rest (p = 0.001).

Conclusions

The use of a tourniquet in primary TKA increased the tibial cement mantle thickness but also increased the postoperative calculated blood loss and postoperative pain. Surgeons might take this into consideration for decision-making whether to use a tourniquet during TKA.

Level of evidence

II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

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

    PubMed  CAS  Google Scholar 

  2. Aglietti P, Baldini A, Vena LM, Abbate R, Fedi S, Falciani M (2000) Effect of tourniquet use on activation of coagulation in total knee replacement. Clin Orthop Relat Res 371:169–177

    Article  PubMed  Google Scholar 

  3. Alcelik I, Pollock RD, Sukeik M, Bettany-Saltikov J, Armstrong PM, Fismer P (2012) A comparison of outcomes with and without a tourniquet in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Arthroplast 27(3):331–340

    Article  Google Scholar 

  4. Argenson JN, Parratte S, Ashour A, Saintmard B, Aubaniac JM (2012) The outcome of rotating-platform total knee arthroplasty with cement at a minimum of 10 years of follow-up. J Bone Joint Surg Am 94(7):638–644

    Article  PubMed  Google Scholar 

  5. Authier B (1988) Reactive hyperemia monitored on rat muscle using perfluorocarbons and 19F NMR. Magn Reson Med 8(1):80–83

    Article  PubMed  CAS  Google Scholar 

  6. Bannister GC, Miles AW (1988) The influence of cementing technique and blood on the strength of the bone-cement interface. Eng Med 17(3):131–133

    Article  PubMed  CAS  Google Scholar 

  7. Barwell J, Anderson G, Hassan A, Rawlings I (1997) The effects of early tourniquet release during total knee arthroplasty: a prospective randomized double-blind study. J Bone Joint Surg Br 79(2):265–268

    Article  PubMed  CAS  Google Scholar 

  8. Bert JM, McShane M (1998) Is it necessary to cement the tibial stem in cemented total knee arthroplasty? Clin Orthop Relat Res 356:73–78

    Article  PubMed  Google Scholar 

  9. Bodian CA, Freedman G, Hossain S, Eisenkraft JB, Beilin Y (2001) The visual analog scale for pain: clinical significance in postoperative patients. Anesthesiology 95(6):1356–1361

    Article  PubMed  CAS  Google Scholar 

  10. Bourke DL, Smith TC (1974) Estimating allowable hemodilution. Anesthesiology 41(6):609–612

    Article  PubMed  CAS  Google Scholar 

  11. Clarius M, Hauck C, Seeger JB, James A, Murray DW, Aldinger PR (2009) Pulsed lavage reduces the incidence of radiolucent lines under the tibial tray of Oxford unicompartmental knee arthroplasty: pulsed lavage versus syringe lavage. Int Orthop 33(6):1585–1590

    Article  PubMed  PubMed Central  Google Scholar 

  12. Coll AM, Ameen JR, Mead D (2004) Postoperative pain assessment tools in day surgery: literature review. J Adv Nurs 46(2):124–133

    Article  PubMed  Google Scholar 

  13. Ewald FC (1989) The knee society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12

    PubMed  Google Scholar 

  14. Feng B, Weng X, Lin J, Jin J, Wang W, Qiu G (2013) Long-term follow-up of cemented fixed-bearing total knee arthroplasty in a Chinese population: a survival analysis of more than 10 years. J Arthroplast 28(10):1701–1706

    Article  Google Scholar 

  15. Galasso O, Jenny JY, Saragaglia D, Miehlke RK (2013) Full versus surface tibial baseplate cementation in total knee arthroplasty. Orthopedics 36(2):151–158

    Article  Google Scholar 

  16. Gruen TA, Markolf KL, Amstutz HC (1976) Effects of laminations and blood entrapment on the strength of acrylic bone cement. Clin Orthop Relat Res 119:250–255

    PubMed  Google Scholar 

  17. Hube R, Keim M, Mayr HO (2009) The mini-midvastus approach for total knee arthroplasty. Oper Orthop Traumatol 21(1):3–13

    Article  PubMed  Google Scholar 

  18. Klenerman L, Chakrabarti R, Mackie I, Brozovic M, Stirling Y (1977) Changes in haemostatic system after application of a tourniquet. Lancet 1(8019):970–972

    Article  PubMed  CAS  Google Scholar 

  19. Kopec M, Milbrandt JC, Duellman T, Mangan D, Allan DG (2009) Effect of hand packing versus cement gun pressurization on cement mantle in total knee arthroplasty. Can J Surg 52(6):490–494

    PubMed  PubMed Central  Google Scholar 

  20. Krause WR, Krug W, Miller J (1982) Strength of the cement-bone interface. Clin Orthop Relat Res 163:290–299

    PubMed  Google Scholar 

  21. Kvederas G, Porvaneckas N, Andrijauskas A, Svensen CH, Ivaskevicius J, Mazunaitis J, Marmaite U, Andrijauskas P (2013) A randomized double-blind clinical trial of tourniquet application strategies for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21(12):2790–2799

    Article  PubMed  Google Scholar 

  22. Larsson J, Lewis DH, Liljedahl SO, Lofstrom JB (1977) Early biochemical and hemodynamic changes after operation in a bloodless field. Eur Surg Res 9(5):311–320

    Article  PubMed  CAS  Google Scholar 

  23. Ledin H, Aspenberg P, Good L (2012) Tourniquet use in total knee replacement does not improve fixation, but appears to reduce final range of motion. Acta Orthop 83(5):499–503

    Article  PubMed  PubMed Central  Google Scholar 

  24. Li B, Wen Y, Wu H, Qian Q, Lin X, Zhao H (2009) The effect of tourniquet use on hidden blood loss in total knee arthroplasty. Int Orthop 33(5):1263–1268

    Article  PubMed  PubMed Central  Google Scholar 

  25. Maistrelli GL, Antonelli L, Fornasier V, Mahomed N (1995) Cement penetration with pulsed lavage versus syringe irrigation in total knee arthroplasty. Clin Orthop Relat Res 312:261–265

    PubMed  Google Scholar 

  26. Majkowski RS, Bannister GC, Miles AW (1994) The effect of bleeding on the cement-bone interface: an experimental study. Clin Orthop Relat Res 299:293–297

    PubMed  Google Scholar 

  27. Manen Berga F, Novellas Canosa M, Angles Crespo F, Bernal Dzekonski J (2002) Effect of ischemic tourniquet pressure on the intensity of postoperative pain. Rev Esp Anestesiol Reanim 49(3):131–135

    PubMed  CAS  Google Scholar 

  28. Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG (2010) Consolidated standards of reporting trials CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol 63(8):1–37

    Article  Google Scholar 

  29. Molt M, Harsten A, Toksvig-Larsen S (2014) The effect of tourniquet use on fixation quality in cemented total knee arthroplasty a prospective randomized clinical controlled RSA trial. Knee 21(2):396–401

    Article  PubMed  Google Scholar 

  30. Peters CL, Craig MA, Mohr RA, Bachus KN (2003) Tibial component fixation with cement: full- versus surface-cementation techniques. Clin Orthop Relat Res 409:158–168

    Article  PubMed  Google Scholar 

  31. Ritter MA, Herbst SA, Keating EM, Faris PM (1994) Radiolucency at the bone-cement interface in total knee replacement: the effects of bone-surface preparation and cement technique. J Bone Joint Surg Am 76(1):60–65

    PubMed  CAS  Google Scholar 

  32. Ryd L, Albrektsson BE, Carlsson L, Dansgard F, Herberts P, Lindstrand A, Regner L, Toksvig-Larsen S (1995) Roentgen stereophotogrammetric analysis as a predictor of mechanical loosening of knee prostheses. J Bone Joint Surg Br 77(3):377–383

    PubMed  CAS  Google Scholar 

  33. Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM (2002) Insall award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res 404:7–13

    Article  PubMed  Google Scholar 

  34. Tai TW, Lin CJ, Jou IM, Chang CW, Lai KA, Yang CY (2011) Tourniquet use in total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 19(7):1121–1130

    Article  PubMed  PubMed Central  Google Scholar 

  35. Tarwala R, Dorr LD, Gilbert PK, Wan Z, Long WT (2014) Tourniquet use during cementation only during total knee arthroplasty: a randomized trial. Clin Orthop Relat Res 472(1):169–174

    Article  PubMed  PubMed Central  Google Scholar 

  36. Tetro AM, Rudan JF (2001) The effects of a pneumatic tourniquet on blood loss in total knee arthroplasty. Can J Surg 44(1):33–38

    PubMed  CAS  PubMed Central  Google Scholar 

  37. Vandenbussche E, Duranthon LD, Couturier M, Pidhorz L, Augereau B (2002) The effect of tourniquet use in total knee arthroplasty. Int Orthop 26(5):306–309

    Article  PubMed  PubMed Central  Google Scholar 

  38. Walker PS, Soudry M, Ewald FC, McVickar H (1984) Control of cement penetration in total knee arthroplasty. Clin Orthop Relat Res 185:155–164

    PubMed  Google Scholar 

  39. Worland RL, Arredondo J, Angles F, Lopez-Jimenez F, Jessup DE (1997) Thigh pain following tourniquet application in simultaneous bilateral total knee replacement arthroplasty. J Arthroplast 12(8):848–852

    Article  CAS  Google Scholar 

  40. Zhang FJ, Xiao Y, Liu YB, Tian X, Gao ZG (2010) Clinical effects of applying a tourniquet in total knee arthroplasty on blood loss. Chin Med J (Engl) 123(21):3030–3033

    Google Scholar 

  41. Zhang W, Li N, Chen S, Tan Y, Al-Aidaros M, Chen L (2014) The effects of a tourniquet used in total knee arthroplasty: a meta-analysis. J Orthop Surg Res 9(1):13

    Article  PubMed  PubMed Central  Google Scholar 

  42. Zhang Y, Li L, Wang J, Li ZH, Shi ZJ (2013) Do patients benefit from tourniquet in arthroscopic surgeries of the knee? Knee Surg Sports Traumatol Arthrosc 21(5):1125–1130

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

Tilman Pfitzner, Philipp von Roth, Ninja Voerkelius, Hermann Mayr and Carsten Perka declare that they have no conflicts of interest. Robert Hube is a consultant for Zimmer.

Author information

Authors and Affiliations

  1. Orthopaedic Department, Center for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Tilman Pfitzner, Philipp von Roth & Carsten Perka

  2. Orthopädische Chirurgie München, Steinerstraße 6, 81369, Munich, Germany

    Ninja Voerkelius, Hermann Mayr & Robert Hube

Authors
  1. Tilman Pfitzner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philipp von Roth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ninja Voerkelius
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hermann Mayr
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carsten Perka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robert Hube
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tilman Pfitzner.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pfitzner, T., von Roth, P., Voerkelius, N. et al. Influence of the tourniquet on tibial cement mantle thickness in primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24, 96–101 (2016). https://doi.org/10.1007/s00167-014-3341-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-014-3341-6

Keywords

Search

Navigation