Clinical Study Of Different Ways To Use A Tourniquet In Total Knee Arthroplasty

Objective: This is a randomized controlled trial to explore the effect of different waysto use a tourniquet in total knee arthroplasty (TKA).We will pay attention to theinfluence of operation time, blood loss, postoperative pain, knee joint swelling andbruising, wound healing, functional recovery and postoperative complications.Methods: We select44TKA in osteoarthritis Ⅳ stage patients（40patients withunilateral knee replacement,4patients with bilateral）from June2012to October2012in The First Affiliated Hospital of Dalian Medical University.40patients with unilateralknee replacement are randomly divided into2groups:18patients with a tourniquet afterosteotomy group（group A）and22patients are full use of tourniquet group(group B).4cases of double knee replacement are use of the two kinds of the tourniquet methods atthe same time.It is a prospective clinical study.We record the operation time of usingtourniquet and the total procedure time, blood loss, preoperative and postoperativehemoglobin (Hb) and hematocrit (HTC) level in1-3days aim to calculate the totalblood loss in operation.We also record the10cm circumference changes of suprapatellarafter3,10,14days，Pain Rating Scale，Limb with or without bruise and incisionexudation，And the flexion angle chang of ipsilateral knee etc.Meanwhile, HSS6weeksafter operation and deep vein thrombosis (DVT) incidence are recorded too and all ofthese data will be compared between these two groups at last.In addition,4cases ofdouble knee replacement were made to support the experiment:one side with atourniquet after osteotomy, the other side full use of tourniquet.Results: The total operation time in the group with a tourniquet after osteotomy is(125±27)minutes, in the full use of tourniquet group is （104±10）minutes.The Hb andHTC of all patients have decreased after the operation,the Hb change in the two groupsis (39.9±13.3)g/l,(32.8±10.5),and the HTC change is (0.12±0.05)g/l,(0.10±0.05)g/l,butthere are no significant differences between the two groups (P>0.05).The total blood loss in operation in the two groups are（1171.4±377.9）ml and（975.0±300.4）ml,thereis no significant difference between them(P>0.05).The pain scale scores of the patientson3,7,14days after the operation in two groups are7.0±0.7，5.4±0.8,4.5±0.6and8.6±0.5，6.8±0.6，5.4±0.8，comparing their differences, the results show that the twogroups’3,7,14days pain score differences are statistically significant (P<0.01).3daysafter operation,The number of limb bruising patients in the two groups is respectively3and4,there is no significant differences(p>0.05).The number of patients with incisionexudation in the two groups is respectively11and18,the difference was statisticallysignificant (P<0.01).10days after operation,patients still have incision exudative are2cases and0cases, the difference has no statistical significance (p>0.05).14days afteroperation, all the patients have no wound exudate.The suprapatellar10cm diameterchange rates of the two groups on3,7,14days after operation are (4.88±4.17)%and(11.65±2.97)%,(2.83±3.19)%and (9.46±2.79)%，(1.50±2.67)%and (7.65±2.72)%,allthe results have statistically significant differences between two groups(P<0.01).HSSscores of knee joint are assessed in all patients before the operation and after6weeks.The result in the group with a tourniquet after osteotomy are47.5±10.1and90.3±3.5, in the full use of tourniquet group are respectively46.7±11.6and91.0±2.3.The improvement rates are (83.07±1.43)%and (82.40±2.93)%.Allpatients preoperative and postoperative HSS scores are statistically significant(p<0.01), and the difference of HSS scores between the two groups after operation andimprovement rates are not statistically significant (p>0.05). No patients are foundhappen to deep venous thrombosis.Conclusion: Full use of a tourniquet in a TKA can significantly reduce the operationtime and blood loss in the surgery, but there is no difference on the total blood loss. Fulluse of a tourniquet patients bear more pain than the use of a tourniquet after osteotomypatients, they need longer time to return to a normal state. Full use of a tourniquetpatients have a higher degree of postoperative ipsilateral knee swelling, and a slowerrecovery time.1-3days after the operation,full use of a tourniquet patients woundexudate more, but no difference in7-10days.Two kinds of tourniquet use method areno difference in the effect of the rehabilitation and improvement of knee function.