Andreas Harsten1, Thomas Bandholm2, Henrik Kehlet3, Sören Toksvig-Larsen4. 1. Dept of Anesthesiology, Hässleholm Hospital and Lund University, Box 351, 281 25 Hässleholm, Sweden. Electronic address: andreas.harsten@skane.se. 2. Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Dept of Physical Therapy, Denmark; Dept of Orthopedic Surgery, Hvidovre Hospital, University of Copenhagen, Denmark; Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Denmark. 3. Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Denmark; Dept of Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Blegdamsvej 9, DK-2100, Denmark. 4. Dept of Orthopedic Surgery, Hässleholm Hospital and Lund University, Box 351, 281 25 Hässleholm, Sweden.
Abstract
BACKGROUND:Thigh tourniquet is commonly used in total knee arthroplasty (TKA) but may contribute to pain and muscle damage. Consequently, the reduction in knee-extension strength after TKA may be caused by quadriceps muscle ischaemia underneath the cuff. AIM: To examine if not using a thigh tourniquet during surgery was more effective than using a thigh tourniquet in preserving knee-extension strength 48 h after fast-track TKA. METHODS: A total of 64 patients undergoing TKA were randomized (1:1) to the use of tourniquet (T-group) or no tourniquet (NT-group). In the T-group the tourniquet cuff pressure was based on the patient's systolic pressure and a margin of 100 mm Hg. It was inflated immediately before surgery and deflated as soon as surgery ended. The primary outcome was the change in knee-extension strength from pre-surgery to 48 h after surgery (primary end point). Secondary outcomes were pain, nausea, length of hospital stay (LOS) and periarticular swelling. RESULTS:Knee-extension strength 48 h after surgery was substantially reduced by about 90% in both groups, with no statistically significant difference between groups (mean difference 1.5 N/kg, 95% CI 1.3-1.6). Among the secondary outcomes, the T-group had less bleeding during surgery (56 vs. 182 mL, P<0.01) compared with the NT-group. There was no difference in postoperative haemoglobin levels, pain, nausea, LOS or periarticular swelling between the groups. CONCLUSION: Not using a thigh tourniquet during surgery was not superior in preserving knee-extension strength at the primary endpoint 48 h after fast-track TKA, compared to using a tourniquet.
RCT Entities:
BACKGROUND: Thigh tourniquet is commonly used in total knee arthroplasty (TKA) but may contribute to pain and muscle damage. Consequently, the reduction in knee-extension strength after TKA may be caused by quadriceps muscle ischaemia underneath the cuff. AIM: To examine if not using a thigh tourniquet during surgery was more effective than using a thigh tourniquet in preserving knee-extension strength 48 h after fast-track TKA. METHODS: A total of 64 patients undergoing TKA were randomized (1:1) to the use of tourniquet (T-group) or no tourniquet (NT-group). In the T-group the tourniquet cuff pressure was based on the patient's systolic pressure and a margin of 100 mm Hg. It was inflated immediately before surgery and deflated as soon as surgery ended. The primary outcome was the change in knee-extension strength from pre-surgery to 48 h after surgery (primary end point). Secondary outcomes were pain, nausea, length of hospital stay (LOS) and periarticular swelling. RESULTS: Knee-extension strength 48 h after surgery was substantially reduced by about 90% in both groups, with no statistically significant difference between groups (mean difference 1.5 N/kg, 95% CI 1.3-1.6). Among the secondary outcomes, the T-group had less bleeding during surgery (56 vs. 182 mL, P<0.01) compared with the NT-group. There was no difference in postoperative haemoglobin levels, pain, nausea, LOS or periarticular swelling between the groups. CONCLUSION: Not using a thigh tourniquet during surgery was not superior in preserving knee-extension strength at the primary endpoint 48 h after fast-track TKA, compared to using a tourniquet.
Authors: Imran Ahmed; Amit Chawla; Martin Underwood; Andrew J Price; Andrew Metcalfe; Charles Hutchinson; Jane Warwick; Kate Seers; Helen Parsons; Peter Dh Wall Journal: Cochrane Database Syst Rev Date: 2020-12-08
Authors: Sergio Castorina; Claudia Guglielmino; Paola Castrogiovanni; Marta Anna Szychlinska; Francesco Ioppolo; Paolo Massimino; Pietro Leonardi; Christian Maci; Maurizio Iannuzzi; Angelo Di Giunta; Giuseppe Musumeci Journal: Muscles Ligaments Tendons J Date: 2018-01-10