1.
Influence of tourniquet use in primary total knee arthroplasty with drainage: a prospective randomised controlled trial
Zhou K, Ling T, Wang H, Zhou Z, Shen B, Yang J, Kang P, Pei F
Journal of Orthopaedic Surgery and Research. 2017;12((1)):172.
Abstract
BACKGROUND We aimed to compare the effect of tourniquet use or lack of it on recovery following uncomplicated primary total knee arthroplasty (TKA). METHODS In a prospective randomised double-blinded study, 150 patients undergoing primary TKA were assigned to either a tourniquet or non-tourniquet group. At the early phase, 3 and 6 months after surgery, an independent observer assessed the primary outcome measure (i.e. total blood loss) and secondary outcome measures (i.e. wound complications, visual analogue scale pain score and knee range of motion). RESULTS The tourniquet group exhibited reduced intraoperative blood loss (215.7 +/- 113.7 ml vs. 138.6 +/- 93.9 ml, P < 0.001) and shorter operating time (77.2 +/- 14.5 min vs. 82.0 +/- 12.7 min, P = 0.038). However, the non-tourniquet group showed less postoperative blood loss (180.2 +/- 117.0 ml vs. 253.7 +/- 144.2 ml, P = 0.001) and drainage volume (89.2 +/- 66.3 ml vs. 164.5 +/- 97.8 ml, P = 0.004), less thigh pain (all P < 0.001) in the initial 3 weeks, better knee range of motion (ROM) in the initial 3 days (day 1 81.6 +/- 17.1 vs. 75.95 +/- 14.55, P = 0.036; day 3 99.8 +/- 13.7 vs. 93.95 +/- 11.15, P = 0.005) and fewer wound tension vesicles (10.3 vs. 29.2%, P = 0.005). Earlier straight-leg raising (4.6 +/- 3.8 h vs. 6.4 +/- 4.3 h, P = 0.01) and shorter length of stay (6.3 +/- 1.7 days vs. 7.1 +/- 1.9 days, P = 0.001) were found in the non-tourniquet group. Similar total blood loss and blood transfusion rate were observed for both groups. All other parameters revealed no significant differences. CONCLUSIONS Our study suggests that a non-tourniquet TKA would lead to early rehabilitation without increasing side effects. TRIAL REGISTRATION Chinese Clinical Trials Registry, ChiCTR-IOR-16007851 , 1/29/2016.
2.
Is postoperative cell salvage necessary in total hip or knee replacement? A meta-analysis of randomized controlled trials
Xie J, Feng X, Ma J, Kang P, Shen B, Yang J, Zhou Z, Pei F
International Journal Of Surgery. 2015;21:135-44.
Abstract
OBJECTIVE The purpose of this study was to determine whether there are hematological or clinical differences with the use of postoperative cell salvage after total knee (TKR) and hip replacement (THR). METHODS A systematic literature review based on PubMed, EMBASE, the Cochrane Library Database in any language regarding postoperative cell salvage following TKR or THR was performed. High quality of randomized controlled trials were identified. The data was analyzed using Rev Man 5.2. RESULTS 19 randomized controlled trials (12 in TKR, 4 in THR and 3 in both) about 3482 patients were identified and included in this meta-analysis. Postoperative cell salvage significantly reduced the allogeneic blood transfusion requirement after TKR (RR = 0.46, 95% CI = 0.30 to 0.72) and THR (RR = 0.46, 95%CI = 0.32 to 0.68). It also demonstrated a higher level of postoperative Hemoglobin (MD = 0.26 g/dL, 95%CI = 0.15 to 0.37) with the use of postoperative cell salvage. No significant differences were detected regarding length of hospital stay, the incidence of febrile reaction, wound infection and deep vein thrombosis. CONCLUSION The results strengthen the fact that postoperative cell salvage is effective and safe to reduce the rate of transfusion after TKR and THR. As the relatively poor methodological quality and heterogeneity, further research is needed to confirm its safety and cost-effectiveness.Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.