A comparison of blood loss and the need for transfusion following primary total knee replacement with or without the use of a tourniquet

Authors

  • Sayyied J. Kirmani Department of Trauma and Orthopaedics, St. Georges Hospital, Tooting, London, UK
  • Mark Middleton Department of Trauma and Orthopaedics, St. Georges Hospital, Tooting, London, UK
  • Andreas Fontalis Department of Trauma and Orthopaedics, St. Georges Hospital, Tooting, London, UK
  • Raka Srivastava Department of Anaesthetic, South West London Elective Centre, Epsom, London, UK
  • Feroz Dinah Department of Trauma and Orthopaedics, South West London Elective Centre, Epsom, London, UK

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20182034

Keywords:

Knee replacement, Tourniquet, Blood loss

Abstract

Background: Primary total knee replacement (TKR) has traditionally been carried out with the use of a tourniquet. More recent trends towards performing the surgery without a tourniquet have had some support in the literature and may improve patient recovery.

Methods: A retrospective cohort of 198 consecutive primary TKRs from our institution were identified and analysed, 52 used a tourniquet and 146 did not. All TKRs also utilised a standardised interventions protocol including withholding of anticoagulants and antiplatelet medications, topical adrenaline injection, and both IV and topical tranexamic acid. Outcomes measured were estimated intra-operative blood loss, overall blood loss through comparison of pre and post-operative haemoglobin laboratory values, and the need for post-operative blood transfusion.

Results: Analysis demonstrated a statistically significant reduction in estimated intra-operative blood loss when a tourniquet was used (p<0.001). However, overall blood loss indicated by the haemoglobin drop after surgery was not significantly affected by tourniquet use (p=0.342). Transfusion requirements were also similar among the groups (4.8% vs. 5.8%) and no tendency was suggested towards an increased rate of transfusion in the non-tourniquet group.

Conclusions: Our study shows that although estimated intra-operative blood loss is increased without a tourniquet, total blood loss as measured by haemoglobin levels is no different for primary TKRs that use a tourniquet and those that do not. Furthermore there is no difference in post-operative blood transfusion rates. It is our hope that this study will add to the body of evidence for surgeons to consider no longer using a tourniquet for primary TKR.

Author Biographies

Sayyied J. Kirmani, Department of Trauma and Orthopaedics, St. Georges Hospital, Tooting, London, UK

ST8 registrar in Trauma and Orthopaedics

Mark Middleton, Department of Trauma and Orthopaedics, St. Georges Hospital, Tooting, London, UK

ST8 registrar in Trauma and Orthopaedics

Andreas Fontalis, Department of Trauma and Orthopaedics, St. Georges Hospital, Tooting, London, UK

Junior Orthopaedic Research Fellow in Trauma and Orthopaedics

Raka Srivastava, Department of Anaesthetic, South West London Elective Centre, Epsom, London, UK

Consultant in Anaesthesia

Feroz Dinah, Department of Trauma and Orthopaedics, South West London Elective Centre, Epsom, London, UK

Consultant in Trauma and Orthopaedics Department

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Published

2018-06-23

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Original Research Articles