Abstract
BackgroundThe role of a tourniquet is still controversial for patients undergoing total knee arthroplasty (TKA). Our current study was performed to determine whether the nonuse of the tourniquet combine with tranexamic acid (TXA) application in TKA patients with end-stage osteoarthritis would accelerate the perioperative recovery rate and provide enough cement mantle thickness for implant fixation.MethodsIn this prospective, randomized controlled trial, 150 end-stage knee osteoarthritis patients receiving TKA were divided into three groups: group A (tourniquet group), group B (non-tourniquet group), and group C (tourniquet in cementation group). All enrolled patients received 3 g of intravenous TXA and 1 g topical TXA. The primary outcomes included blood loss variables and transfusion values. The secondary outcomes included VAS pain score, inflammatory factors level, range of motion, HSS score, postoperative hospital stay, and complication. Furthermore, by using a digital linear tomosynthesis technique, tibial baseplate bone cement mantle thickness was measured in four zones based on the knee society scoring system.ResultsNo significant difference was found among the three groups with regards to total blood loss, transfusion, and complication. However, patients in group B showed lower inflammatory factors levels, shorter length of hospital stay, better range of motion, and lower postoperative pain. No significant difference was found among the three groups in four zones in terms of bone cement mantle thickness.ConclusionsFor end-stage knee osteoarthritis patients, the absence of tourniquet did not appear to affect blood loss and cement penetration in TKA patients. Furthermore, less inflammation reaction and better knee function can be achieved without a tourniquet. We recommend no longer use a tourniquet in primary TKA for patients with end-stage osteoarthritis when TXA is administrated.Trial registrationChiCTR-INR-16009026.Level of evidenceTherapeutic Level I.
Highlights
The role of a tourniquet is still controversial for patients undergoing total knee arthroplasty (TKA)
Patients One hundred seventy four patients were diagnosed with end-stage osteoarthritis and scheduled to have TKA in Surgical results and complications Table 2 reveals the results of perioperative assessment results
We found intraoperative blood loss in patients of the tourniquet group was significantly less than patients in non-tourniquet and
Summary
In this prospective, randomized controlled trial, 150 end-stage knee osteoarthritis patients receiving TKA were divided into three groups: group A (tourniquet group), group B (non-tourniquet group), and group C (tourniquet in cementation group). The secondary outcomes included VAS pain score, inflammatory factors level, range of motion, HSS score, postoperative hospital stay, and complication. Approval was obtained from the Clinical Trials and Biomedical Ethics Committee of West China Hospital (No 201302007) and all methods were carried out in accordance with relevant guidelines and regulations (Declaration of Helsinki). All the patients enrolled were diagnosed with end-stage osteoarthritis (OA). Exclusion criteria included: a history of hypercoagulation, hemophilia, deep vein thrombosis (DVT), pulmonary embolism (PE); previous surgery to the knee; bleeding disorders, platelet of bone marrow disorders; patients were diagnosed with other diseases, such as rheumatoid arthritis; patients with diabetes, peripheral neurovascular disease, malignant tumor; preoperative Hb < 100 g/L. The duration of postoperative follow-up in this study was 3 months
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