Tourniquet and closed-suction drains in total knee arthroplasty. No beneficial effects on bleeding management and knee function at a higher cost - 29/11/17
, A. Banica a, A. Senay c, P. Ranger a, b, G.Y. Laflamme a, b, J. Jun d, J. Fernandes a, b
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Abstract |
Background |
Blood loss is a major concern in total knee arthroplasty (TKA) along with postoperative knee function. The present study explores the impact of tourniquet (T) and closed-suction drains (D) on these parameters in TKA.
Materials and methods |
A prospective study was conducted on 111 patients admitted for TKA. Subjects were divided into three groups: 36 in group T+D+, 42 in T−D+ and 33 in T−D− (where T+: prolonged tourniquet use, T−: cementation-only tourniquet, D+: closed-suction drain use, and D−: no drain).
Results |
No statistically significant differences were observed among the three groups(T+D+, T-D+ and T−D−) for total blood loss, hemoglobin levels over the first six postoperative weeks and blood transfusion rate. Intraoperative bleeding was significantly reduced in T+ subjects compared to T− subjects (100±88mL vs. 279±235mL respectively, P<0.001), yet length of surgery was unaffected. Hidden blood loss was lower in D+ subjects compared to D− subjects (1161±554mL vs. 1667±554mL respectively, P<0.001), but was offset by the blood loss in the drains. Early postoperative range of motion (ROM) was superior in group T−D− compared to group T+D+. Nevertheless, postoperative week 6 ROM was similar between the 3 groups as was patient-reported postoperative pain. A patient with a drain represents 35min of extra nursing time and a total cost of $31.87 CAD.
Conclusions |
Whole-course tourniquet and closed-suction drain use in TKA do not yield beneficial results while increasing costs. Their use is therefore deemed unnecessary.
Level of evidence |
III (case control prospective study).
Le texte complet de cet article est disponible en PDF.Keywords : Total knee arthroplasty, Tourniquet, Drainage, Blood transfusion, Blood loss, Complications, Range of motion
Plan
Vol 103 - N° 4
P. 583-589 - juin 2017 Retour au numéro
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