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COMPARSION OF DEEP VENOUS THROMBOSIS BETWEEN USING READY TO USE STERILE TOURNIQUET AND PNEUMATIC TOURNIQUET AT TOTAL KNEE ARTHROPLASTY SURGERY

Year 2018, Volume: 19 Issue: 3, 93 - 97, 23.07.2018
https://doi.org/10.18229/kocatepetip.446846

Abstract

ABSTRACT
OBJECTIVE: We aimed to compare the incidence of deep
vein thrombosis (DVT) after total knee arthroplasty with
the use of sterile elastic tourniquet and the pneumatic
tourniquet.

MATERIAL AND METHODS: From 2005 to 2012, 754
patients undergoing Total knee prosthesis (TKP) were
included in this study. Two groups have been formed
considering patient number, sex and weight. At the
first group, 377 patients have been operated using
pneumatic tourniquet. Sterile tourniquet was also used
in 377 patients at the second group. Both groups were
evaluated for biochemical tests which related to clotting.
Patients showing preoperative DVT or receiving
anticoagulants were excluded. Patients with known
factor deficiency were also excluded from this study.
All patients were operated by same surgeon group and
mean operation time was 60 (45-100) minutes. All of the
patients were mobilised after 19 (10-28) hours. Ankle
flexion and extension exercises was performed after
following motor block. Mean hospitalization time was 5
(3-9) days. Patients were controlled in the first and fourth
weeks after discharge from the hospital. During this
time, patients have been evaluated with clinical findings
and lower extremity doppler ultrasonography for DVT.
Patients who had developed DVT, have been treated by
cardiovascular surgery department.

RESULTS: 165 (21.8%) of the 754 patient had DVT. 124
(32.8%) of these patients was in the first group and 41
(10.8%) was in the second group. 21 (2.7%) patients had
pulmonary embolism, 19 (5%) patients were in the first
group and 2 (0.5%) of these were in the second group. We
observed a significant difference between the groups,
with a frequency of DVT and pulmonary embolism.
(p<0.05). Demographic characteristics were similar in
both groups.

CONCLUSIONS: When pneumatic tourniquet was used,
spasms had been developed in 30-40 centimeter segment
at lower extremity because of circular compressive
forces. On the other hand, this segment was only two
centimeters when sterile tourniquet was preferred.
When affected segment was larger, increasing venous
thrombosis risk were shown because of venous intima
damage. We thought that the use of a sterile tourniquet
decreased the incidence of DVT . 

References

  • Berry DJ, Bozic KJ. Current practice patterns in primaryhip and knee arthroplasty among members of the American association of hip and knee surgeons. J Arthroplasty 2010; 25(6 Suppl):2–4.
  • Norman D, Greenfield I, Ghrayeb N, et al. Use of a new exsanguination tourniquet in internal fixation of distal radius fractures. Tech Hand Up Extrem Surg 2009;13(4):8.
  • Silverstein MD, Heit JA, Mohr DN, et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med. 1998;158(6):585-93.
  • David H. Green. Green’s Operative Hand Surgery . Ed.3 Vol: 1, New York: Churchill-Livingstone, 1993: 5-11.
  • Shaw JA, Murray DG. The relationship between tourniquet pressure and underlying soft-tissue pressure in the thigh. J Bone Joint Surg Am. 1982;64(8):1148-52
  • Barnes RW, Nix ML, Barnes CL, et al: Perioperative asymptomatic venous thrombosis: role of duplex scanningm versus venography. J Vasc Surg 1989;9:250–61.
  • Woolson ST. The resolution of deep venous thrombosis that occurs after total joint arthroplasty. A study of thrombi treated with anticoagulation and observed by repeat venous ultrasound scans. Clin Orthop 1994;299:86–91.
  • Cheng KK, Lai ST, Yu TJ, et al. Postoperative deep veinö thrombosis in the Taiwanese Chinese population. Am J Surg 1987;153:302–5.
  • Nandi P, Wong KP, Wei WI, et al. Incidence of postoperative deep vein thrombosis in Hong Kong Chinese. Br J Surg 1980;67:251–3.
  • Chau KY, Yuen ST, Ng TK, et al. An autopsy study of pulmonary thromboembolism in Hong Kong Chinese. Pathology 1991;23:181–4.
  • Feldman V, Biadsi A, Slavin O, et al. Pulmonary Embolism After Application of a Sterile Elastic Exsanguination Tourniquet. Orthopedics. 2015;38(12):e1160-3.
  • Parmet JL, Horrow JC, Berman AT, et al. The incidence of large venous emboli during total knee arthroplasty without pneumatic tourniquet use. Anesth Analg 1998, 2(87):439–444.
  • Desai S, Prashantha PG, Torgal SV, et al. Fatal pulmonary embolism subsequent to the use of Esmarch bandage and tourniquet: a case report and review of literature. Saudi J Anaesth. 2013; 7(3):331-335.
  • Zahavi J, Price AJ, Westwick J, et al. Enhanced in-vivo platelet release reaction, increased thromboxane synthesis, and decreased prostacyclin release after tourniquet ischaemia. Lancet 1980; 8196(2):663–667.
  • Katsumata S, Nagashima M, Kato K, et al. Changes in coagulation-fibrinolysis marker and neutrophil elastase following the use of tourniquet during total knee arthroplasty and the influence of neutrophil elastase on thromboembolism. Acta Anaesthesiol Scand 2005; 4(49):510–516.
  • Brin YS, Feldman V, Ron Gal I, et al. The Sterile Elastic Exsanguination Tourniquet vs. the Pneumatic Tourniquet for Total Knee Arthroplasty. J Arthroplasty. 2015;30(4):595-9

TOTAL DİZ REPLASMANI UYGULANAN STERİL HAZIR TURNİKE İLE PNÖMOTİK TURNİKENİN AMELİYAT SONRASI DÖNEMDE DERİN VENTROMBOZU OLUŞUMU YÖNÜNDEN KARŞILAŞTIRILMASI

Year 2018, Volume: 19 Issue: 3, 93 - 97, 23.07.2018
https://doi.org/10.18229/kocatepetip.446846

Abstract

ÖZ
AMAÇ: Total diz replasmanında kullanılan steril elastik
hazır turnike ile pnömotik turnikenin ameliyat sonrası
dönemde gelişebilen derin ven trombozu oluşumuna etkisini
incelemek ve sonuçlarını bildirmek.

GEREÇ VE YÖNTEM: 2005-2012 yılları arasında total diz
replasmanında (TDR) uygulanan 754 hasta çalışmaya
alındı. Hasta sayısı, cinsiyet ve ağırlıkları göz önünde
bulundurularak 2 ayrı grup oluşturuldu. 1. gruptaki 377
vakaya pnömotik turnike, 2. gruba aynı sayıda hazır steril
turnike kullanıldı. Her iki grup pıhtılaşmayı etkileyen
biyokimyasal değerler yönünden incelendi. Pıhtılaşmaya
etkileyen ilaç kullanımı, faktör eksikliği, geçirilmiş derin
ven trombozu veya riskine sahip hastalar çalışmaya
alınmadı. Tüm hastalara aynı cerrahi grup tarafından
operasyon gerçekleştirilmiş olup ortalama operasyon
süresi 60,2±4,12 (45-100) dakika olarak tespit edildi. Tüm
hastalar ortalama19,5±2,18 (10-28) saat sonra mobilize
edildi, motor blok bitiminde ayak fleksiyon-ekstansiyon
hareketleri uygulatıldı. Hastalar ortalama 5,14±0,92 (3-
9) gün hospitalize edildi. Taburcu sonrası 1-4. haftalarda
kontrole çağrıldı. Bu süre zarfında hastalar derin ven
trombozu açısından klinik ve ultrasonografik olarak alt
ekstremite venöz doppler tetkiki uygulandı. Derin ven
trombozu (DVT) pozitif olan hastalara Kardiyovasküler
cerrahi tarafından tedavi başlandı.

BULGULAR: İncelenen 754 hasta içinde 165’ inde (%21.8)
DVT tespit edildi. Bunlardan 1. grupta 124 (%32.8) 2.
grupta ise 41(%10.8) di. Pulmoner emboli 21 (%2.7)
hastada teşhis edilirken 1. grupta 19 (%5) 2. grupta
ise sadece 2 (%0.5) hastada saptandı. İki grup DVT ve
pulmoner emboli gelişimi açısından anlamlı bulundu.
(p<0.05). Her iki grupta incelenen demografik özellikler
benzerdi.

SONUÇ: Pnömotik turnike uygulanması esnasında alt
extremitede yaklaşık 30-40 cm lik bir segmentte sirküler
kompresif güçlere bağlı spazm oluşmaktadır, buna
karşılık hazır steril turnikede bu genişlik yaklaşık 2 cm
dir. Etki altında kalan segment uzunluğu arttıkça damar
intimasında olası hasarlanma nedeniyle venöz tromboz
riskinin artabildiği görülmektedir. Hazır steril turnikelerin
DVT açısından daha az riskli olduğu görülmektedir.

References

  • Berry DJ, Bozic KJ. Current practice patterns in primaryhip and knee arthroplasty among members of the American association of hip and knee surgeons. J Arthroplasty 2010; 25(6 Suppl):2–4.
  • Norman D, Greenfield I, Ghrayeb N, et al. Use of a new exsanguination tourniquet in internal fixation of distal radius fractures. Tech Hand Up Extrem Surg 2009;13(4):8.
  • Silverstein MD, Heit JA, Mohr DN, et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med. 1998;158(6):585-93.
  • David H. Green. Green’s Operative Hand Surgery . Ed.3 Vol: 1, New York: Churchill-Livingstone, 1993: 5-11.
  • Shaw JA, Murray DG. The relationship between tourniquet pressure and underlying soft-tissue pressure in the thigh. J Bone Joint Surg Am. 1982;64(8):1148-52
  • Barnes RW, Nix ML, Barnes CL, et al: Perioperative asymptomatic venous thrombosis: role of duplex scanningm versus venography. J Vasc Surg 1989;9:250–61.
  • Woolson ST. The resolution of deep venous thrombosis that occurs after total joint arthroplasty. A study of thrombi treated with anticoagulation and observed by repeat venous ultrasound scans. Clin Orthop 1994;299:86–91.
  • Cheng KK, Lai ST, Yu TJ, et al. Postoperative deep veinö thrombosis in the Taiwanese Chinese population. Am J Surg 1987;153:302–5.
  • Nandi P, Wong KP, Wei WI, et al. Incidence of postoperative deep vein thrombosis in Hong Kong Chinese. Br J Surg 1980;67:251–3.
  • Chau KY, Yuen ST, Ng TK, et al. An autopsy study of pulmonary thromboembolism in Hong Kong Chinese. Pathology 1991;23:181–4.
  • Feldman V, Biadsi A, Slavin O, et al. Pulmonary Embolism After Application of a Sterile Elastic Exsanguination Tourniquet. Orthopedics. 2015;38(12):e1160-3.
  • Parmet JL, Horrow JC, Berman AT, et al. The incidence of large venous emboli during total knee arthroplasty without pneumatic tourniquet use. Anesth Analg 1998, 2(87):439–444.
  • Desai S, Prashantha PG, Torgal SV, et al. Fatal pulmonary embolism subsequent to the use of Esmarch bandage and tourniquet: a case report and review of literature. Saudi J Anaesth. 2013; 7(3):331-335.
  • Zahavi J, Price AJ, Westwick J, et al. Enhanced in-vivo platelet release reaction, increased thromboxane synthesis, and decreased prostacyclin release after tourniquet ischaemia. Lancet 1980; 8196(2):663–667.
  • Katsumata S, Nagashima M, Kato K, et al. Changes in coagulation-fibrinolysis marker and neutrophil elastase following the use of tourniquet during total knee arthroplasty and the influence of neutrophil elastase on thromboembolism. Acta Anaesthesiol Scand 2005; 4(49):510–516.
  • Brin YS, Feldman V, Ron Gal I, et al. The Sterile Elastic Exsanguination Tourniquet vs. the Pneumatic Tourniquet for Total Knee Arthroplasty. J Arthroplasty. 2015;30(4):595-9
There are 16 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Tansel MUTLU This is me

Uygar DAŞAR

Publication Date July 23, 2018
Acceptance Date May 28, 2018
Published in Issue Year 2018 Volume: 19 Issue: 3

Cite

APA MUTLU, T., & DAŞAR, U. (2018). TOTAL DİZ REPLASMANI UYGULANAN STERİL HAZIR TURNİKE İLE PNÖMOTİK TURNİKENİN AMELİYAT SONRASI DÖNEMDE DERİN VENTROMBOZU OLUŞUMU YÖNÜNDEN KARŞILAŞTIRILMASI. Kocatepe Tıp Dergisi, 19(3), 93-97. https://doi.org/10.18229/kocatepetip.446846
AMA MUTLU T, DAŞAR U. TOTAL DİZ REPLASMANI UYGULANAN STERİL HAZIR TURNİKE İLE PNÖMOTİK TURNİKENİN AMELİYAT SONRASI DÖNEMDE DERİN VENTROMBOZU OLUŞUMU YÖNÜNDEN KARŞILAŞTIRILMASI. KTD. July 2018;19(3):93-97. doi:10.18229/kocatepetip.446846
Chicago MUTLU, Tansel, and Uygar DAŞAR. “TOTAL DİZ REPLASMANI UYGULANAN STERİL HAZIR TURNİKE İLE PNÖMOTİK TURNİKENİN AMELİYAT SONRASI DÖNEMDE DERİN VENTROMBOZU OLUŞUMU YÖNÜNDEN KARŞILAŞTIRILMASI”. Kocatepe Tıp Dergisi 19, no. 3 (July 2018): 93-97. https://doi.org/10.18229/kocatepetip.446846.
EndNote MUTLU T, DAŞAR U (July 1, 2018) TOTAL DİZ REPLASMANI UYGULANAN STERİL HAZIR TURNİKE İLE PNÖMOTİK TURNİKENİN AMELİYAT SONRASI DÖNEMDE DERİN VENTROMBOZU OLUŞUMU YÖNÜNDEN KARŞILAŞTIRILMASI. Kocatepe Tıp Dergisi 19 3 93–97.
IEEE T. MUTLU and U. DAŞAR, “TOTAL DİZ REPLASMANI UYGULANAN STERİL HAZIR TURNİKE İLE PNÖMOTİK TURNİKENİN AMELİYAT SONRASI DÖNEMDE DERİN VENTROMBOZU OLUŞUMU YÖNÜNDEN KARŞILAŞTIRILMASI”, KTD, vol. 19, no. 3, pp. 93–97, 2018, doi: 10.18229/kocatepetip.446846.
ISNAD MUTLU, Tansel - DAŞAR, Uygar. “TOTAL DİZ REPLASMANI UYGULANAN STERİL HAZIR TURNİKE İLE PNÖMOTİK TURNİKENİN AMELİYAT SONRASI DÖNEMDE DERİN VENTROMBOZU OLUŞUMU YÖNÜNDEN KARŞILAŞTIRILMASI”. Kocatepe Tıp Dergisi 19/3 (July 2018), 93-97. https://doi.org/10.18229/kocatepetip.446846.
JAMA MUTLU T, DAŞAR U. TOTAL DİZ REPLASMANI UYGULANAN STERİL HAZIR TURNİKE İLE PNÖMOTİK TURNİKENİN AMELİYAT SONRASI DÖNEMDE DERİN VENTROMBOZU OLUŞUMU YÖNÜNDEN KARŞILAŞTIRILMASI. KTD. 2018;19:93–97.
MLA MUTLU, Tansel and Uygar DAŞAR. “TOTAL DİZ REPLASMANI UYGULANAN STERİL HAZIR TURNİKE İLE PNÖMOTİK TURNİKENİN AMELİYAT SONRASI DÖNEMDE DERİN VENTROMBOZU OLUŞUMU YÖNÜNDEN KARŞILAŞTIRILMASI”. Kocatepe Tıp Dergisi, vol. 19, no. 3, 2018, pp. 93-97, doi:10.18229/kocatepetip.446846.
Vancouver MUTLU T, DAŞAR U. TOTAL DİZ REPLASMANI UYGULANAN STERİL HAZIR TURNİKE İLE PNÖMOTİK TURNİKENİN AMELİYAT SONRASI DÖNEMDE DERİN VENTROMBOZU OLUŞUMU YÖNÜNDEN KARŞILAŞTIRILMASI. KTD. 2018;19(3):93-7.

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