ARTHROPLASTY
Tourniquet use in total knee replacement does not improve fixation, but appears to reduce final range of motion
This report has been verified
by one or more authors of the
original publication.
この研究はハイインパクトの可能性があります。
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これにより、臨床的に意義のある研究をより早く認識することが可能になり、読者は将来の診療を形成する可能性が最も高い論文に集中することができます。
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(11):53 Acta Orthop. 2012 Oct;83(5):499-503. doi: 10.3109/17453674.2012.727078. Epub 2012 Sep 14.50 patients undergoing total knee arthroplasty were included in this trial to determine the effect of tourniquet use on implant migration. Patients were randomized to undergo cemented total knee arthroplasty with or without the use of a tourniquet. The results of this study indicate that the use of a tourniquet did not reduce implant migration, caused more postoperative pain, and reduced range of motion.
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)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
3/4
Randomização
3/4
Medidas de resultado
3/4
Inclusão/Exclusão
4/4
Descrição do tratamento
4/4
Estatística
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
Tourniquets are routinely used during total knee replacement to reduce bleeding which might impair fixation of the cemented prosthesis. However, tourniquet use is associated with re-perfusion trauma, oxidative stress, deep vein thrombosis risk, and injury due to pressure on skin, muscles, nerves, and arteriosclerotic vessels. Tourniquets may also reduce the surgical field, which may lead to a number of other complications and jeopardize the sterility of the postoperative dressing. This study aimed to determine the effects of tourniquet use on patients undergoing cemented total knee arthroplasty.
主な研究課題は何ですか？
Does tourniquet use reduce postoperative migration and improve clinical outcomes in patients, 2 years after undergoing cemented total knee arthroplasty?
重要な知見は？
- The difference in migration, between the patients who received a tourniquet and the patients who did not, was not significant: 0.01 mm (95% CI: -0.13 to 0.15).
- The patients who received a tourniquet experienced significantly more pain during the first 4 postoperative days than the patients who did not receive and tourniquet (49 mm versus 41 mm; p=0.01).
- Tourniquet use significantly reduced total overt bleeding when compared to no tourniquet use (317 mL versus 615 mL; p=0.002), but did not significantly reduce the total bleeding estimated by hemoglobin dilution (1184 mL versus 1236 mL).
- There was no significant difference in morphine consumption between the patients who received a tourniquet and the patients who did not receive a tourniquet.
- The mean range of motion at 2 years for the patients in the tourniquet group was 113 degrees, whereas the mean range of motion for the patients in the control group was 124 degrees (p=0.001).
最も覚えておくべきことは？
Tourniquet use did not significantly alter migration of the cemented total knee arthroplasty and may cause significantly more postoperative pain and reduce range of motion when compared to no tourniquet use.
それが私の患者ケアにどのように影響するか？
It is still unclear if tourniquet use during total knee arthroplasty is efficacious. Although its use can reduce operative blood loss, it may effect implant fixation/migration, postoperative pain and range of motion. Further randomized trials are needed to determine if tourniquet use has any effect on implant fixation and migration, and if any differences detected have a clinically significant impact on long-term outcomes.
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