Influence of the Tourniquet on Pain and Function in Total Knee Arthroplasty: a Systematic Review and Meta-Analysis

Abstract Background The use of the tourniquet in total knee arthroplasty is still a subject of controversial discussion. Previous studies mainly focus on parameters like blood loss and operation time. The aim of this systematic review is to evaluate the postoperative outcome involving parameters such as pain intensity, analgesic consumption, knee function and complication rate with and without tourniquet use, to find a recommendation for future application in total knee arthroplasty. Material and Methods This review is based on the PRISMA Checklists. A systematic research was performed in PubMed using the key words “tourniquet”, “total knee arthroplasty”, “TKA” and “knee endoprosthesis” up to and including January 2018. The initial search revealed 686 Papers which were extracted by the parameters intensity of pain, analgesic consumption, function (range of motion, Hospital for Special Surgery Score, Knee Society Score) and complications (deep vein thrombosis, surgical side infection, pulmonary embolism). The program Review Manager Version 5.3 was used for statistical analysis. A significance level of p < 0,05 was defined. Results 18 studies were included in this review with 1279 total knee arthroplasties overall (646 with the use of tourniquet and 633 without). The analysis shows a significant lower pain intensity until the fifth postoperative day (p = 0,03) and also after one to three months (p = 0,04) without using the tourniquet. Range of motion is significantly higher in two to three days postoperatively (p < 0,00 001) when the surgery was performed without tourniquet. Knee Society Score shows no difference between the two groups. A deep vein thrombosis appears significantly more often when using a tourniquet (p = 0,04). There was no higher occurrence in pulmonary embolism and surgical side infections. Conclusion The use of a pneumatic tourniquet in total knee arthroplasty affects especially the early postoperative pain and functional recovery.

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One Versus Two Doses of Intravenous Tranexamic Acid in Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0039-1700805 ◽

2019 ◽

Author(s):

Ryan S. Charette ◽

Jenna A. Bernstein ◽

Matthew Sloan ◽

Corbyn M. Nchako ◽

Atul F. Kamath ◽

...

Keyword(s):

Pulmonary Embolism ◽

Total Knee Arthroplasty ◽

Deep Vein Thrombosis ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Transfusion Rate ◽

Vein Thrombosis ◽

Total Knee ◽

Deep Vein

AbstractTranexamic acid (TXA) has been shown to reduce blood loss and postoperative transfusions in total knee arthroplasty (TKA). There is no consensus on the ideal dosing regimen in the literature, although there is a growing body of literature stating there is little benefit to additional doses. Our study compared one versus two doses of TXA in primary TKA and its effect on postoperative transfusion rate. We retrospectively reviewed patients undergoing primary TKA at our two high-volume arthroplasty centers between 2013 and 2016. Patients were included if they underwent unilateral primary TKA, and received one or two doses of intravenous TXA. Patients receiving therapeutic anticoagulation were excluded. Our primary outcome was postoperative transfusion rate. Secondary outcomes included blood loss, length of stay, rate of deep vein thrombosis or pulmonary embolism (DVT/PE), readmission and reoperation.A total of 1,191 patients were included: 891 received one dose and 300 received two doses. There was no significant difference in rate of transfusion, deep vein thrombosis or pulmonary embolism (DVT/PE), blood volume loss, and reoperation. There was a significantly higher risk of readmission (6.7 vs. 2.4%, odds ratio [OR] 2.96, p < 0.001) and reoperation (2.0 vs. 0.6%, OR 3.61, p = 0.024) in patients receiving two doses. These findings were similar with subgroup analysis of patients receiving only aspirin prophylaxis.In unilateral TKA, there is no difference in transfusion rate with one or two doses of perioperative TXA. There was no increased risk of thromboembolic events between groups, although the two-dose group had a higher rate of readmission and reoperation. Given the added cost without clear benefit, these findings may support administration of one rather than two doses of TXA during primary TKA.

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RIVAROXABAN IN THE PROPHYLAXIS AGAINST VENOUS THROMBOEMBOLISM AFTER TOTAL KNEE ARTHROPLASTY- A PROSPECTIVE STUDY IN A TERTIARY CARE CENTRE

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i7.1288 ◽

2020 ◽

Vol 4 (7) ◽

Author(s):

V. Abhilash Rao ◽

Mukka Naveen

Keyword(s):

Pulmonary Embolism ◽

Total Knee Arthroplasty ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Knee Arthroplasty ◽

Once Daily ◽

Vein Thrombosis ◽

Total Knee ◽

A Prospective Study ◽

Deep Vein

Background: Venous thromboembolism (VTE) is a major healthcare problem that affects more than 1.6 million persons each year worldwide. Patients undergoing major orthopedic surgery, total knee arthroplasty (TKA), and total hip arthroplasty (THA) are at high risk for developing VTE, which can manifest as deep vein thrombosis (DVT) or pulmonary embolism (PE), and PE can be life-threatening. It is a preventable complication of in-hospital mortality. The prophylaxis to prevent VTE varies from vitamin K antagonists like warfarin, low molecular weight heparin like enoxaparin, Fondaparinox sodium, direct factor Xa inhibitor like rivaroxaban and apixiban, mechanical thromboprophylaxis. Materials and Methods: Presented is a prospective study to see the efficacy of Oral rivaroxaban 10mg once daily dose for 14 days in the prevention of VTE in 60 elective cases total knee arthroplasty. The study was done from June 2017- October 2018 in the department of orthopaedics, Prathima institute of medical sciences, Nagunur, Karimnagar. All the operated cases were cemented with cruciate retaining prosthesis. Oral Rivaroxaban 10mg was given after 6-8 hours after wound closure and continued for 14 days. All the patients were closely monitored for signs and symptoms of DVT, PE with Wells DVT score followed by venous angiogram and signs of pulmonary embolism evaluated with modified Gurd and Wilson criteria and subsequent CT pulmonary angiogram. Results: In study involving 60 primary total knee replacement cases, only one patient developed deep venous thromboembolism (1.6%) with oral Rivaroxaban. No cases of bleeding manifestations or pulmonary embolism were reported. Conclusion: once daily oral dose of rivaroxaban 10mg for 14 days is an effective modality in preventing the number of cases of VTE after Total knee arthroplasty. The ease of administration of oral agents compared to subcutaneously given agents like Enoxaparin will lead to better patient compliance and early discharge from hospital. Key words: Venous thromboembolism, Total knee arthroplasty, Rivaroxaban, Deep vein thrombosis, Pulmonary embolism

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