Skip to main content

Advertisement

Log in

The effect of tourniquet use on hidden blood loss in total knee arthroplasty

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

The objective of this study was to examine the characteristics of hidden blood loss and assess the effects of using a tourniquet on postoperative hidden loss in patients undergoing primary total knee arthroplasty. Eighty patients were randomised into two groups: one group underwent operation with a tourniquet and one without. Operating time, perioperative blood loss, hidden blood loss, free haemoglobin, swelling, ecchymosis, straight leg raising action and knee flexion were measured. There were significant differences in the hidden blood loss, free haemoglobin, postoperative swelling, extent of ecchymosis, straight leg raising and postoperative knee flexion in the early period after operation between the two groups. Our results indicate that knee arthroplasty operations with a tourniquet might promote postoperative hidden blood loss and hinder patients’ in early postoperative rehabilitation exercises.

Résumé

L’objectif de l’étude est de déterminer les caractéristiques des pertes sanguines occultes et les effets de l’utilisation du garrot sur ces pertes sanguines dans les prothèses totales du genou primaires. Matériel et méthode: les patients ont été randomisés en deux groupes, un groupe a été opéré sous garrot et un groupe sans garrot. Le temps opératoire, les pertes sanguines péri-opératoires et occultes, le taux d’hémoglobine, l’hématome, l’ecchymose, la possibilité d’extension active et de flexion du genou ont été mesurés. Résultats: il y a une différence significative sur les pertes sanguines occultes, le taux d’hémoglobine, les douleurs post-opératoires, les ecchymoses, l’élévation active de la jambe et la flexion du genou post-opératoire. En conclusion, nos résultats montrent que la prothèse totale du genou avec garrot, peut entraîner des pertes de sang occultes chez les patients notamment en cours de la rééducation post-opératoire.

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

Access this article

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

Instant access to the full article PDF.

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 77:250–253

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  3. Aglietti P, Baldini A, Vena LM et al (2000) Effect of tourniquet use on activation of coagulation in total knee replacement. Clin Orthop Relat Res 371:169–177

    Article  PubMed  Google Scholar 

  4. Appell HJ, Glöser S, Duarte JA, Zellner A, Soares JM (1993) Skeletal muscle damage during tourniquet-induced ischaemia. The initial step towards atrophy after orthopaedic surgery? Eur J Appl Physiol Occup Physiol 67:342–347

    Article  PubMed  CAS  Google Scholar 

  5. Carson JL, Duff A, Poses RM et al (1996) Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet 348:1055–1060

    Article  PubMed  CAS  Google Scholar 

  6. Erskine JG, Fraser C, Simpson R et al (1981) Blood loss with knee joint replacement. J R Coll Surg Edinb 26:295–297

    PubMed  CAS  Google Scholar 

  7. Fahmy NR, Patel DG (1981) Hemostatic changes and postoperative deep-vein thrombosis associated with use of a pneumatic tourniquet. J Bone Joint Surg Am 63:461–465

    PubMed  CAS  Google Scholar 

  8. Gross JB (1983) Estimating allowable blood loss: corrected for dilution. Anesthesiology 58:277–280

    Article  PubMed  CAS  Google Scholar 

  9. Harvey EJ, Leclerc J, Brooks CE, Burke DL (1997) Effect of tourniquet use on blood loss and incidence of deep vein thrombosis in total knee arthroplasty. J Arthroplasty 12:291–296

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  11. McManus KT, Velchik MG, Alavi A, Lotke PA (1987) Non-invasive assessment of postoperative bleeding in TKA patients with Tc-99m RNCs. J Nucl Med 28:565–567

    Google Scholar 

  12. Mylod AG, France MP, Muser DE et al (1990) Perioperative blood loss associated with total knee arthroplasty. A comparison of procedures performed with and without cementing. J Bone Joint Surg Am 72:1010–1012

    PubMed  Google Scholar 

  13. Nadler SB, Hidalgo JU, Bloch T (1962) Prediction of blood volume in normal human adults. Surgery 51:224–232

    Google Scholar 

  14. Nakahara M, Sakahashi H (1967) Effect of application of a tourniquet on bleeding factors in dogs. J Bone Joint Surg Am 49:1345–1351

    PubMed  CAS  Google Scholar 

  15. Ömeroğlu H, Erdoğan D, Ömeroğlu S, Günel U, Biçimoğlu A (1997) Ultrastructural analysis of the alterations in skeletal muscle during tourniquet application on extremities (in Turkish). Acta Orthop Traumatol Turc 31:323–326

    Google Scholar 

  16. Prasad N, Padmanabhan V, Mullaji A (2007) Blood loss in total knee arthroplasty: an analysis of risk factors. Int Orthop 31:39–44

    Article  PubMed  Google Scholar 

  17. Pattison E, Protheroe K, Pringle RM et al (1973) Reduction in haemoglobin after knee joint surgery. Ann Rheum Dis 32:582–584

    Article  PubMed  CAS  Google Scholar 

  18. Rama KR, Apsingi S, Poovali S, Jetti A (2007) Timing of tourniquet release in knee arthroplasty. Meta-analysis of randomized, controlled trials. J Bone Joint Surg Am 89:699–705

    Article  PubMed  Google Scholar 

  19. Sehat KR, Evans RL, Newman JH (2000) How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account. Knee 7:151–155

    Article  PubMed  Google Scholar 

  20. Silver R, de la Garza J, Rang M, Koreska J (1986) Limb swelling after release of a tourniquet. Clin Orthop 206:86–89

    PubMed  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  22. Tao K, Wu HS, Li XH et al (2006) The use of a closed-suction drain in total knee arthroplasty: a prospective, randomized study (in Chinese). Zhonghua Wai Ke Za Zhi 44:1111–1115

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  24. Wakankar HM, Nicholl JE, Koka R, D’Arcy JC (1999) The tourniquet in total knee arthroplasty. A prospective, randomised study. J Bone Joint Surg Br 81:30–33

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Haishan Wu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Li, B., Wen, Y., Wu, H. et al. The effect of tourniquet use on hidden blood loss in total knee arthroplasty. International Orthopaedics (SICOT) 33, 1263–1268 (2009). https://doi.org/10.1007/s00264-008-0647-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-008-0647-3

Keywords

Navigation