ARTHROPLASTY
Faster recovery without the use of a tourniquet in total knee arthroplasty
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(20):4 Acta Orthop. 2014 Aug;85(4):422-6. doi: 10.3109/17453674.2014.931197. Epub 2014 Jun 23.70 patients with stage 3-5 gonarthrosis were randomized to undergo total knee arthroplasty (TKA) with or without the application of a tourniquet. The purpose of this trial was to determine whether TKA should be performed with or without the use of a tourniquet, based on functional and clinical outcomes at one year postoperatively. Results revealed that TKA without the use of a tourniquet significantly improved KOOS functional outcomes and knee range of motion up to 8 weeks after surgery, but resulted in greater intraoperative bleeding compared to TKA using a tourniquet. However, neither group required transfusion following TKA.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
4/4
Randomization
2/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
Tourniquets are frequently used to reduce intraoperative bleeding during total knee arthroplasty (TKA). While they may offer the potential to improve blood loss, visual field, surgical time, and quality of cementation, they are also associated with postoperative disadvantages including heightened pain, reduced muscle strength, and limited knee range of motion. Thus, this study was needed to investigate whether the advantages of tourniquet use during TKA outweigh the potential for adverse effects. The authors hypothesized non-tourniquet patients would achieve improved functional outcomes, increased knee range of motion, reduced postoperative pain, and lowered analgesic consumption.
Qual era a principal questão de investigação?
How does total knee arthroplasty with and without the use of a tourniquet compare with respect to functional and clinical outcomes over the first postoperative year?
Quais foram os resultados importantes?
- The tourniquet and non-tourniquet groups both improved in all KOOS sub-scales (pain, symptoms, function in daily living, function in sport/rec, knee related quality of life) from baseline to 8 weeks, with significant improvement in the non-tourniquet group compared to the tourniquet group at day 2 postoperative (p<0.05).
- Knee range of motion was significantly superior in the non-tourniquet group compared to the tourniquet group day 2 postoperative (48 (SD 9.5, 95% CI: 44-51) degrees vs. 36 (SD 7.9, 95% CI: 33-39) degrees; p < 0.001) and 8 weeks after surgery (100 (SD 7.2, 95% CI: 97-102) degrees vs. 93 (SD 8.2, 95% CI: 90-6) degrees; p = 0.002). This difference was no longer detectable at the 6 or 12 month follow-up (both p>0.05).
- In the non-tourniquet group: mean VAS pain was significantly lower day 2 postoperative (4.6 (SD 1.4, 95% CI: 4.1-5.1) vs. 5.5 (SD 1.6, 95% CI: 5-6.1); p<0.02), analgesic consumption was lower, intraoperative bleeding was greater (280 (SD 52) mL vs. 140 (SD 32.7) mL) and surgical time/visibility was similar compared to the tourniquet group.
- No patients required transfusions.1 patient in the non-tourniquet group and 2 patients in the tourniquet group experienced deep vein thrombosis.
De que é que me devo lembrar mais?
Total knee arthroplasty (TKA) without the use of a tourniquet improved KOOS functional outcomes and knee range of motion up to 8 weeks after surgery, but resulted in greater intraoperative bleeding compared to tourniquet use. However, no patient in either group required transfusion.
Como é que isto afectará o tratamento dos meus doentes?
Other than increased intraoperative bleeding, which did not lead to an increased need for transfusion, the absence of a tourniquet in total knee arthroplasty does not appear to result in any additional complications. In fact, the aforementioned findings found the absence of a tourniquet resulted in superior functional outcome, improved knee range of motion, as well as reduced pain and analgesia consumption compared to TKA with a tourniquet. Additional trials are required to confirm these results.
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