Tourniquet application only during cement fixation in total knee arthroplasty: a double-blind, randomized controlled trial

Authors

  • Rajat Mittal,

    Corresponding author
    1. South Western Sydney Local Health Network, Orthopaedic Department, Liverpool Hospital, Liverpool, New South Wales, Australia
    2. South West Sydney Clinical School, University of New South Wales, Liverpool Hospital, Liverpool, New South Wales, Australia
    3. Whitlam Orthopaedic Research Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
      Dr Rajat Mittal, Department of Orthopaedic Surgery, Liverpool Hospital, Locked Bag 7103, Liverpool, BC, NSW 1871, Australia. Email: rajatmittal.syd@gmail.com
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  • Victoria Ko,

    1. Whitlam Orthopaedic Research Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
    2. South Western Sydney Local Health Network, Orthopaedic Department, Fairfield Hospital, Fairfield, New South Wales, Australia
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  • Sam Adie,

    1. South Western Sydney Local Health Network, Orthopaedic Department, Liverpool Hospital, Liverpool, New South Wales, Australia
    2. South West Sydney Clinical School, University of New South Wales, Liverpool Hospital, Liverpool, New South Wales, Australia
    3. Whitlam Orthopaedic Research Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
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  • Justine Naylor,

    1. South Western Sydney Local Health Network, Orthopaedic Department, Liverpool Hospital, Liverpool, New South Wales, Australia
    2. South West Sydney Clinical School, University of New South Wales, Liverpool Hospital, Liverpool, New South Wales, Australia
    3. Whitlam Orthopaedic Research Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
    4. South Western Sydney Local Health Network, Orthopaedic Department, Fairfield Hospital, Fairfield, New South Wales, Australia
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  • Jaykar Dave,

    1. South Western Sydney Local Health Network, Orthopaedic Department, Liverpool Hospital, Liverpool, New South Wales, Australia
    2. South Western Sydney Local Health Network, Orthopaedic Department, Fairfield Hospital, Fairfield, New South Wales, Australia
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  • Chandrakant Dave,

    1. South Western Sydney Local Health Network, Orthopaedic Department, Liverpool Hospital, Liverpool, New South Wales, Australia
    2. South Western Sydney Local Health Network, Orthopaedic Department, Fairfield Hospital, Fairfield, New South Wales, Australia
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  • Ian A. Harris,

    1. South Western Sydney Local Health Network, Orthopaedic Department, Liverpool Hospital, Liverpool, New South Wales, Australia
    2. South West Sydney Clinical School, University of New South Wales, Liverpool Hospital, Liverpool, New South Wales, Australia
    3. Whitlam Orthopaedic Research Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
    4. South Western Sydney Local Health Network, Orthopaedic Department, Fairfield Hospital, Fairfield, New South Wales, Australia
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  • Danella Hackett,

    1. South Western Sydney Local Health Network, Orthopaedic Department, Fairfield Hospital, Fairfield, New South Wales, Australia
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  • David Ngo,

    1. South Western Sydney Local Health Network, Orthopaedic Department, Fairfield Hospital, Fairfield, New South Wales, Australia
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  • Susan Dietsch

    1. South Western Sydney Local Health Network, Orthopaedic Department, Fairfield Hospital, Fairfield, New South Wales, Australia
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  • R. Mittal BSc (Med), MBBS, MMed (Clin Epi); V. Ko. BAppSc (Phty) (Hons); S. Adie BSc (Med), MBBS, MSpMed, MPH; J. Naylor BAppSc (Phty), PhD; J. Dave MBBS, FRACS (Ortho); C. Dave MBBS, FRACS (Ortho); I. A. Harris MBBS, MMed (Clin Epi), FRACS (Ortho), PhD; D. Hackett M Phty, BAppSc (Ex & Sp Sc); D. Ngo BAppSc (Phty); S. Dietsch BHlthSc (Nurs), DipAppSci (Nurs), GC Nurs (Ortho).

Dr Rajat Mittal, Department of Orthopaedic Surgery, Liverpool Hospital, Locked Bag 7103, Liverpool, BC, NSW 1871, Australia. Email: rajatmittal.syd@gmail.com

Abstract

Background:  The functional benefits of tourniquet application for short periods compared with standard duration applications during total knee arthroplasty surgery have not been well explored. We aimed to compare functional outcomes between tourniquet application of short duration (during cement fixation only) and tourniquet application of longer duration (from skin incision to just after cement fixation).

Methods:  We planned to randomize 230 patients to short and long duration groups. The primary outcome was Oxford Knee Score at 10 weeks post-surgery. In-hospital blood transfusion rate was also a primary safety measure. Serial measures of knee function were taken together with knee range, quadriceps lag and timed stair tests.

Results:  The trial was discontinued after randomization of 65 patients. Interim analysis indicated a higher risk of transfusion (odds ratio 7.38, P= 0.015) in the short duration group. No significant difference was observed in Oxford Knee Score at 10 weeks. There were no between-group differences in rate of recovery up to 52 weeks for any outcome.

Conclusions:  Restricting tourniquet application to the period of cementing is associated with a significantly higher risk of transfusion. This approach is impractical if it is not offset by gains in functional recovery.

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