Efficacy and safety of a new elastic tourniquet cuff in total knee arthroplasty: a prospective randomized controlled study

O-Sung Lee,Hyuk-Soo Han,Myung Chul Lee

doi:10.1186/s12938-017-0393-0

Abstract

BackgroundThe effects of cuff shape, timing of tourniquet application, and automated systems using limb occlusion pressure (LOP) have been reported to minimize the appropriate tourniquet pressure. However, studies on the raw material of the cuff itself to reduce the complications related to the tourniquet have been very rarely reported. The purpose of this study is to report the efficacy and safety of a tourniquet system with a new elastic cuff in which pressure is set with LOP in total knee arthroplasty (TKA).MethodsA total of 63 patients who underwent primary TKA for osteoarthritis were enrolled from July to December 2015. Thirty-one patients were allocated to the new elastic cuff group and 32 in the conventional cuff group. Bloodless surgical field, pain visual analog scale (VAS) on the thigh, thigh circumference, range of motion, incidence of deep vein thrombosis, and muscle enzyme level after surgery were checked and compared between the 2 groups.ResultsOnly 1 of the 31 patients in the elastic cuff group required more pressure for obtaining a bloodless surgical field, whereas 4 of the 32 patients in the conventional cuff group required more pressure to complete surgery without being disturbed by sustained bleeding. Two patients in the conventional cuff group needed treatment for blisters and bullae at the tourniquet application site. There was no difference in pain VAS score, thigh circumference, range of motion, incidence of deep vein thrombosis, and level of muscle enzyme.ConclusionsA new elastic tourniquet cuff provided a more proper bloodless surgical field with less adjustment of tourniquet pressure despite a similar level of tourniquet pressure compared to the conventional cuff and had a low incidence of skin complications on the site of tourniquet application in TKA. These benefits make it an effective and safe medical device for orthopedic surgery requiring a tourniquet, such as TKA.

Highlights

The effects of cuff shape, timing of tourniquet application, and auto‐ mated systems using limb occlusion pressure (LOP) have been reported to minimize the appropriate tourniquet pressure
Automated pneumatic tourniquet system based on the LOP and elastic cuff The automated pneumatic tourniquet system (DTS-3000, DSMAREF, KOR), which was used in this trial, consist of main control part and power control part (Fig. 2)
The recommended tourniquet pressure (RTP) based on LOP is automatically set through the algorithm, which the users can set a safety margin according to the LOP

Summary

Introduction

The effects of cuff shape, timing of tourniquet application, and auto‐ mated systems using limb occlusion pressure (LOP) have been reported to minimize the appropriate tourniquet pressure. The pneumatic tourniquet is an efficient device to achieve a bloodless surgical field in orthopedic surgeries It is a well-known method to provide such bloodless surgical field, facilitate cementation, and reduce the duration of surgery, especially in primary total knee arthroplasties (TKAs). Many studies have reported the effect of the shape of the cuff, timing of tourniquet application, and automated tourniquet system to minimize the proper tourniquet pressure [5,6,7]. As one of the effective methods to reduce tourniquet pressure to occlude blood flow distal to the tourniquet application site, tourniquet systems using minimal limb occlusion pressure (LOP) were introduced [7, 8]. It has been well known that tourniquet inflation pressures with these LOP systems were generally lower than the inflation pressures based on the surgeon’s experiences [10]

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