Stephen G Zak1, Alex Tang1, Robert Pivec2, Morteza Meftah1, Matthew S Austin2, Erik Schnaser3, Ran Schwarzkopf4. 1. Division of Adult Reconstruction, NYU Langone Orthopedic Hospital, Hospital for Joint Diseases, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA. 2. Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA. 3. Desert Orthopedic Center, Eisenhower Medical Center, Rancho Mirage, CA, USA. 4. Division of Adult Reconstruction, NYU Langone Orthopedic Hospital, Hospital for Joint Diseases, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA. ran.schwarzkopf@nyulangone.org.
Abstract
PURPOSE: Aseptic loosening is a common cause of implant failure following total knee arthroplasty (TKA). Cement penetration depth is a known factor that determines an implant's "strength" and plays an important role in preventing aseptic loosening. Tourniquet use is thought to facilitate cement penetration, but its use has mixed reviews. The aim of this study was to compare cement penetration depth between tourniquet and tourniquet-less TKA patients. METHODS: A multicenter retrospective review was conducted. Patients were randomized preoperatively to undergo TKA with or without the use of an intraoperative tourniquet. The variables collected were cement penetration measurements in millimeters (mm) within a 1-month post-operative period, length of stay (LOS), and baseline demographics. Measurements were taken by two independent raters and made in accordance to the zones described by the Knee Society Radiographic Evaluation System and methodology used in previous studies. RESULTS: A total of 357 TKA patients were studied. No demographic differences were found between tourniquet (n = 189) and tourniquet-less (n = 168) cohorts. However, the tourniquet cohort had statistically, but not clinically, greater average cement penetration depth [2.4 ± 0.6 mm (range 1.2-4.1 mm) vs. 2.2 ± 0.5 mm (range 1.0-4.3 mm, p = 0.01)]. Moreover, the tourniquet cohort had a significantly greater proportion of patients with an average penetration depth within the accepted zone of 2 mm or greater (78.9% vs. 67.3%, p = 0.02). CONCLUSION: Tourniquet use does not affect average penetration depth but increases the likelihood of achieving optimal cement penetration depth. Further study is warranted to determine whether this increased likelihood of optimal cement penetration depth yields lower revision rates.
PURPOSE: Aseptic loosening is a common cause of implant failure following total knee arthroplasty (TKA). Cement penetration depth is a known factor that determines an implant's "strength" and plays an important role in preventing aseptic loosening. Tourniquet use is thought to facilitate cement penetration, but its use has mixed reviews. The aim of this study was to compare cement penetration depth between tourniquet and tourniquet-less TKA patients. METHODS: A multicenter retrospective review was conducted. Patients were randomized preoperatively to undergo TKA with or without the use of an intraoperative tourniquet. The variables collected were cement penetration measurements in millimeters (mm) within a 1-month post-operative period, length of stay (LOS), and baseline demographics. Measurements were taken by two independent raters and made in accordance to the zones described by the Knee Society Radiographic Evaluation System and methodology used in previous studies. RESULTS: A total of 357 TKA patients were studied. No demographic differences were found between tourniquet (n = 189) and tourniquet-less (n = 168) cohorts. However, the tourniquet cohort had statistically, but not clinically, greater average cement penetration depth [2.4 ± 0.6 mm (range 1.2-4.1 mm) vs. 2.2 ± 0.5 mm (range 1.0-4.3 mm, p = 0.01)]. Moreover, the tourniquet cohort had a significantly greater proportion of patients with an average penetration depth within the accepted zone of 2 mm or greater (78.9% vs. 67.3%, p = 0.02). CONCLUSION: Tourniquet use does not affect average penetration depth but increases the likelihood of achieving optimal cement penetration depth. Further study is warranted to determine whether this increased likelihood of optimal cement penetration depth yields lower revision rates.
Authors: Jan Vanlommel; Jean Philippe Luyckx; Luc Labey; Bernardo Innocenti; Ronny De Corte; Johan Bellemans Journal: J Arthroplasty Date: 2010-04-08 Impact factor: 4.757
Authors: Zachary A Gapinski; Elliott J Yee; Kent R Kraus; Evan R Deckard; R Michael Meneghini Journal: J Arthroplasty Date: 2019-03-28 Impact factor: 4.757
Authors: Chadwick B Hampton; Zachary P Berliner; Joseph T Nguyen; Logan Mendez; Sarah S Smith; Amethia D Joseph; Douglas E Padgett; José A Rodriguez Journal: J Arthroplasty Date: 2020-02-24 Impact factor: 4.757