Total Diz Artroplastisinde Cerrahi Süresince Pnömatik Turnike Kullanımı ile Çimentolama Sırasında Pnömatik Turnike Kullanılmasının Erken Dönem Kan Kaybı Üzerinde Etkisi

Abstract

Objectives: Tourniquet is used at total knee arthroplasty (TKA) for decreasing intra-operative blood loss and to provide a blood free exposure. However, there are many discrepancies for the ideal tourniquet technique. Our study aims to compare two tourniquet using techniques, throughout the surgery vs. only at the time of cementing components, by means of early blood loss retrospectively at TKA. Materials and Methods: Four hundred and seven patients were enrolled to our study where 153 of them were operated with tourniquet inflated for all the TKA surgery while 254 of them operated with the tourniquet inflated only at the time of cementation. Hemoglobin (Hb), hematocrit (Htc), platelet (Plt), white blood cell counts for pre-operative and postoperative period and early postoperative need for blood transfusion data were extracted. Results: Results revealed that for both groups Hb, Htc and Plt levels drop postoperatively while the there was no difference in-between groups. Also, the need for blood transfusion was not significantly different. Conclusion: Our results confirm with the help of supplementary measures like tranexamic acid and hypotensive anesthesia tourniquet use for only cementing the components is effective as prolonged usage of tourniquet by means of early blood loss at TKA. We also believe this kind of tourniquet regimen will reduce complications.

Keywords

• Knee Arthroplasty
• Tourniquet
• Blood Loss

Total Diz Artroplastisinde Cerrahi Süresince Pnömatik Turnike Kullanımı ile Çimentolama Sırasında Pnömatik Turnike Kullanılmasının Erken Dönem Kan Kaybı Üzerinde Etkisi

Abstract

Amaç: Total diz protezi (TDP) cerrahisi sırasında turnike kullanımı intraoperatif kan kaybını ve cerrahi saha görünümünü artırmak için kullanılmaktadır. Ancak güncel literatürde turnike kullanım teknikleri ile değişik sonuçlar bulunmaktadır. Retrospektif olarak planladığımız çalışmamızın amacı; TDP cerrahisi süresi boyunca turnike kullanılmış hastalar ile, yalnızca çimentolama esnasında turnike kullanılmış hastaların postoperatif kan kaybı ve kan transfüzyon ihtiyaçlarını belirleyerek intraoperatif turnike kullanım süresinin postoperatif kan kaybına etkisini irdelemektir. Gereç ve Yöntem: Çalışmamıza 407 hasta dahil edilmiş olup 153 hastanın (grup 1) tüm TDP cerrahisi süresinde turnike kullanılmış, 254 hastanın ise cerrahi içerisinde sadece çimentolama aşamasında turnike kullanılmıştır. Hastaların preoperatif ve postoperatif hemoglobin (Hb), hemotokrit (Htc), trombosit (Plt), beyaz küre ve postoperatif kan transfüzyon ihtiyaçları karşılaştırılmıştır. Bulgular: Çalışmamız sonucunda her iki grup içinde postoperatif Hb, Htc, Plt değerleri açısından anlamlı düşüş saptanır (p<0,05) iken iki grup arasında istatistiksel anlamlı fark saptanmamıştır (p>0,05). Benzer şekilde, iki grup arasında postoperatif kan transfüzyon ihtiyacı açısından da istatistiksel anlamlı fark saptanmamıştır. Sonuç: Çalışmamız sonucunda elde ettiğimiz veriler ışığında; intraoperatif kullanılan transamin ve diğer kanama azaltıcı yöntemler ile beraber sadece çimentolama sırasında kullanılan turnike uygulaması postoperatif kan kaybı ve kan transfüzyon ihtiyacı için, tüm cerrahi süresince kullanılan turnike yöntemi kadar etkili bir yöntemdir. Buna ek olarak turnike bağlı gelişen postoperatif komplikasyonları azaltıcı bir yöntem olduğu düşünülmektedir.

Keywords

• Diz Artroplastisi
• Turnike
• Kan KaybI

References

1. 1. Abdel-Salam A, Eyres KS. Effects of tourniquet during total knee arthroplasty. A prospective randomised study. J Bone Joint Surg Br 1995;77:250-253.
2. 2. Tetro AM, Rudan JF. The effects of a pneumatic tourniquet on blood loss in total knee arthroplasty. Can J Surg 2001;44:33-38.
3. 3. Fukuda A, Hasegawa M, Kato K, et al. Effect of tourniquet application on deep vein thrombosis after total knee arthroplasty. Arch Orthop Trauma Surg 2007;127:671-675.
4. 4. Aglietti P, Baldini A, Vena LM, et al. Effect of tourniquet use on activation of coagulation in total knee replacement. Clin Orthop Relat Res 2000;371:169-177.
5. 5. Lee YH, Wei FC, Lee J, et al. Effect of post-ischaemic reperfusion on microcirculation and lipid metabolism of skeletal muscle. Microsurgery 1995;16:522-527.
6. 6. Harvey EJ, Leclerc J, Brooks CE, et al. Effect of tourniquet use of blood loss and incidence of deep vein thrombosis in total knee arthroplasty. J Arthroplasty 1997;12:291-296.
7. 7. Wakankar HM, Nicholl JE, Koka R, et al. The tourniquet in total knee arthroplasty. A prospective, randomised study. J Bone Joint Surg Br 1999;81:30-33.
8. 8. Palmer SH, Graham G. Tourniquet-induced rhabdomyolysis after total knee replacement. Ann R Coll Surg Engl 1994;76:416-417.

9. 9. Silver R, de la Garza J, Rang M, et al. Limb swelling after release of a tourniquet. Clin Orthop Relat Res 1986;206:86-89.
10. 10. Klenerman L. The tourniquet in surgery. J Bone Joint Surg Br 1962;44:937-943.
11. 11. Klenerman L, Crawley J. Limb blood flow in the presence of a tourniquet. Acta Orthop Scand 1977;48:291-295.
12. 12. Klenerman L. The tourniquet in operations on the knee: a review. J R Soc Med 1982;75:31-32.
13. 13. Padala PR, Rouholamin E, Mehta RL. The role of drains and tourniquets in primary total knee replacement: a comparative study of TKR performed with drains and tourniquet versus no drains and adrenaline and saline infiltration. J Knee Surg 2004;17:24-27.
14. 14. McGrath BJ, Hsia J, Epstein B. Massive pulmonary embolism following tourniquet deflation. Anaesthesiology 1991;74:618-620.
15. 15. Patterson S, Klenerman L. The effect of pneumatic tourniquet on the ultrastructure of skeletal muscle. J Bone Joint Surg Br 1979;61:178-183.
16. 16. Shenton DW, Spitzer SA, Mulrennan BM. Tourniquet-induced rhabdomyolysis: a case report. J Bone Joint Surg Am 1990;72:1405-1406.
17. 17. Vaishya R, Agarwal AK, Vijay V, et al. Short term outcomes of long duration versus short duration tourniquet in primary total knee arthroplasty: A randomized controlled trial. J Clin Orthop Trauma 2018;9:46-50.
18. 18. Connelly JO, Edwards PK, Mears SC, et al. Technique for Periarticular Local Infiltrative Anesthesia Delivery Using Liposomal Bupivacaine in Total Knee Arthroplasty. J Surg Orthop Adv 2015;24:263-266.
19. 19. Ishii Y, Matsuda Y. Effect of the timing of tourniquet release on perioperative blood loss associated with cementless total knee arthroplasty: a prospective randomized study. J Arthroplasty 2005;20:977-983.
20. 20. Saunders KC, Louis DL, Weingarden SL, et al. Effect of tourniquet time on post-operative quadriceps function. Clin Orthop 1979;143:194-197.
21. 21. Lee YH, Wei FC, Lee J, et al. Effect of postischaemic reperfusion on microcirculation and lipid metabolism of skeletal muscle. Microsurgery 1995;16:522-527.
22. 22. Lotke PA, Faralli VJ, Orenstein EM, et al. Blood loss after total knee replacement: effects of tourniquet release and continuous passive motion. J Bone Joint Surg Am 1991;73:1037-1040.
23. 23. Tai TW, Lin CJ, Jou IM, et al. Tourniquet use in total knee arthroplasty: a meta- analysis. Knee Surg Sports Traumatol Arthrosc 2011;19:1121-1130.
24. 24. Jarolem KL, Scott DF, Jaffe WL, et al. A comparison of blood loss and transfusion requirements in total knee arthroplasty with and without arterial tourniquet. Am J Orthop (Belle Mead NJ) 1995;12:906-908.
25. 25. Wauke K, Nagashima M, Kato N, et al. Comparative study between thromboembolism and total knee arthroplasty with or without tourniquet in rheumatoid arthritis patients. Arch Orthop Trauma Surg 2002;122:442-446.
26. 26. Jiang FZ, Zhong HM, Hong YC, et al. Use of a tourniquet in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Orthop Sci 2015;20:110-123.
27. 27. Smith TO, Hing CB. Is a tourniquet beneficial in total knee replacement surgery? A meta-analysis and systematic review. Knee 2010;17:141-147.