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Zentralbl Chir 2003; 128(10 ): 866-870
DOI: 10.1055/s-2003-44339
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© Georg Thieme Verlag Stuttgart · New York

Die Auswirkung der Oberschenkelblutsperre auf den Blutverlust in der Knieendoprothetik

Effect of Tourniquet Use on Blood Loss in Total Knee ArthroplastyA. Schuh 1 , M. Hausel2 , S. Salminen3
  • 1Orthopädische Klinik Rummelsberg, Schwarzenbruck
  • 2Abteilung für Unfall- und Wiederherstellungschirurgie, Klinikum Weiden
  • 3Helsinki University Central Hospital, Dept. of Orthopaedics and Traumatology and Dept. of Pediatric Orthopaedics, Finland
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Publication History

Publication Date:
20 November 2003 (online)

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Zusammenfassung

Einleitung: Um den Blutverlust in der Knieendoprothetik zu minimieren, wurden eine Reihe von physikalischen Maßnahmen versucht, mitunter die Oberschenkelblutsperre. Es besteht Klärungsbedarf, wann diese geöffnet werden soll.
Patienten und Methode: Unter der Vorstellung, durch eine sorgfältige Blutstillung vor dem Wundverschluss den Blutverlust und damit verbunden die Häufigkeit von Bluttransfusionen reduzieren zu kö nnen, analysierten wir in einer prospektiv-randomisierten Studie im Zeitraum von 1/1996 bis 6/1998 70 konsekutive Knieprothesenimplantationen wegen Gonarthrose (41 Männer, 29 Frauen) eines Operateurs. In Gruppe I wurde die Oberschenkelblutsperre vor, in Gruppe II nach dem Wundverschluss geöffnet.
Ergebnisse: Wir fanden keine statistisch signifikanten Unterschiede zwischen beiden Gruppen beim geschätzten Blutverlust, dem postoperativen Hämoglobin- und Hämatokritabfall und der Häufigkeit der Bluttransfusionen. In Gruppe II sahen wir zwei tiefe Beinvenenthrombosen. Dieser Unterschied war statistisch nicht signifikant.
Schlussfolgerung: Wir kommen zu dem Schluss, dass die Dauer der Oberschenkelblutsperre keinen Einfluss auf den Blutverlust und die Häufigkeit von Bluttransfusionen in der Knieendoprothetik hat.

Abstract

Aim: To reduce blood loss in total knee arthroplasty various physical measures including the use of a tourniquet are recommended. The question of an early tourniquet release is still unsettled.
Patients and method: To confirm our theory that blood loss and need of blood transfusions might be reduced while removing the tourniquet for meticulous hemostasis before wound closure we analysed 70 (41 male, 29 female) consecutive patients with total knee arthroplasty for osteoarthritis performed by a single surgeon in a prospective-randomized study between 1/1996 to 6/1998. In group I the tourniquet was released before, in group II after wound closure.
Results: We couldn't find any significant differences in the estimated blood loss, the decrease of hemoglobin and hematocrit level, and the transfusion need. In Group II we observed two cases of deep vein thrombosis. This difference was not significant.
Conclusion: We conclude that tourniquet release for hemostasis is not an effective tool in reducing blood loss or transfusion need in total knee arthroplasty.

Schlüsselwörter

Knieendoprothetik - Oberschenkelblutsperre - Wundverschluss - Blutverlust

Key words

Total knee arthroplasty - tourniquet - wound closure - blood loss

Literatur

  • 1 Abdel-Salam A, Eyres K S. Effects of tourniquet during total knee arthroplasty. A prospective randomised study.  J Bone Joint Surg [Br]. 1995;  77 250-253
    PubMedGoogle Scholar
  • 2 Barwell J, Anderson G, Hassan A, Rawlings I. The effects of early tourniquet release during total knee arthroplasty: a prospective randomized double-blind study.  J Bone Joint Surg [Br ]. 1997;  79 265-268
    PubMedGoogle Scholar
  • 3 Benoni G, Lethagen S, Fredin H. The effect of tranexamic acid on local and plasma fibrinolysis during total knee arthroplasty.  Thromb Res. 1997;  85 195-206
    CrossrefPubMedGoogle Scholar
  • 4 Berman A T, Geissele A E, Bosacco S J. Blood loss with total knee arthroplasty.  Clin Orthop. 1988;  234 137-138
    PubMedGoogle Scholar
  • 5 Bourke D L, Smith T C. Estimating allowable hemodilution.  Anesthesiology. 1974;  41 609-612
    CrossrefPubMedGoogle Scholar
  • 6 Burkart B C, Bourne R B, Rorabeck C H, Kirk P G, Nott L. The efficacy of tourniquet release in blood conservation after total knee arthroplasty.  Clin Orthop. 1994;  299 147-152
    PubMedGoogle Scholar
  • 7 Clarke M T, Longstaff L, Edwards D, Rushton N. Tourniquet-induced wound hypoxia after total knee replacement.  J Bone Joint Surg [Br]. 2001;  83 40-44
    PubMedGoogle Scholar
  • 8 Crews J C, Cahall M A. An investigation of the neurophysiologic mechanisms of tourniquet-related pain: changes in spontaneous activity and receptive field size in spinal dorsal horn neurons.  Reg Anesth Pain Med. 1999;  24 102-109
    CrossrefPubMedGoogle Scholar
  • 9 Cushner F D, Friedman R J. Blood loss in total knee arthroplasty.  Clin Orthop. 1991;  269 98-101
    PubMedGoogle Scholar
  • 10 DeLee J C, Rockwood C A. Current concepts review: the use of aspirin in thromboembolic disease.  J Bone Joint Surg [Am]. 1980;  62 149-152
    PubMedGoogle Scholar
  • 11 Dobner J J, Nitz A J. Postmeniscectomy tourniquet palsy and functional sequelae.  Am J Sports Med. 1982;  10 211-214
    PubMedGoogle Scholar
  • 12 Dodenhoff R M. Effect of ketorolac tromethamine on bleeding and on requirements for analgesia after total knee arthroplasty.  J Bone Joint Surg [Am]. 1996;  78 968
    PubMedGoogle Scholar
  • 13 Erskine J G, Fraser C, Simpson R, Protheroe K, Walker I D. Blood loss with knee joint replacement.  J R Coll Surg Edin. 1981;  26 295-297
    PubMedGoogle Scholar
  • 14 Francis C W, Pellegrini V D, Stulberg B N. et al . Prevention of venous thrombosis after total knee arthroplasty: Comparison of antithrombin III and low-dose heparin with dextran.  J Bone Joint Surg [Am]. 1990;  72 976-982
    PubMedGoogle Scholar
  • 15 Gross J B. Estimating allowable blood loss: corrected for dilution.  Anesthesiology. 1983;  58 277-280
    CrossrefPubMedGoogle Scholar
  • 16 Harvey E J, Leclerc J, Brooks C E, Burke D L. Effect of tourniquet use on blood loss and incidence of deep vein thrombosis in total knee arthroplasty.  J Arthroplasty. 1997;  12 291-296
    CrossrefPubMedGoogle Scholar
  • 17 Hiippala S T, Strid L J, Wennerstrand M I. et al . Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty.  Anesth Analg. 1997;  84 839-844
    CrossrefPubMedGoogle Scholar
  • 18 Holt B T, Parks N L, Engh G A, Lawrence J M. Comparison of closed-suction drainage and no drainage after primary total knee arthroplasty.  Orthopedics. 1997;  20 1121-1124
    PubMedGoogle Scholar
  • 19 Jarolem K L, Scott D F, Jaffe W L. et al . A comparison of blood loss and transfusion requirements in total knee arthroplasty with and without arterial tourniquet.  Am J Orthop. 1995;  24 906-909
    PubMedGoogle Scholar
  • 20 Jorn L P, Lindstrand A, Toksvig-Larsen S. Tourniquet release for hemostasis increases bleeding. A randomized study of 77 knee replacements.  Acta Orthop Scand. 1999;  70 265-267
    PubMedGoogle Scholar
  • 21 Leclerc J R, Geerts W H, Desjardins L. et al . Prevention of deep vein thrombosis after knee surgery: a randomized, double blind trial comparing a low molecular weight heparin fragment (enoxaparin) to placebo.  Thromb Haemostas. 1992;  67 417-423
    PubMedGoogle Scholar
  • 22 Leclerc J R, Geerts W H, Desjardins L. et al . Prevention of venous thromboembolism after knee arthroplasty: a randomized, double blind trial comparing a low molecular weight heparin fragment (enoxaparin) to warfarin.  Ann Intern Med. 1996;  124 619-626
    PubMedGoogle Scholar
  • 23 Levy A S, Marmar E. The role of cold compression dressings in the postoperative treatment of total knee arthroplasty.  Clin Orthop. 1993;  297 174-178
    PubMedGoogle Scholar
  • 24 Lotke P A, Faralli V J, Orenstein E M, Ecker M L. Blood loss after total knee replacement. Effects of tourniquet release and continuous passive motion.  J Bone Joint Surg [Am]. 1991;  73 1037-1040
    PubMedGoogle Scholar
  • 25 Lynch A F, Bourne R B, Rorabeck C H. et al . Deep-vein thrombosis and continuous passive motion after total knee arthroplasty.  J Bone Joint Surg [Am]. 1988;  70 11-14
    PubMedGoogle Scholar
  • 26 Manen Berga F, Novellas Canosa M, Angles Crespo F, Bernal Dzekonski J. Effect of ischemic tourniquet pressure on the intensity of postoperative pain.  Rev Esp Anestesiol Reanim. 2002;  49 131-135
    PubMedGoogle Scholar
  • 27 Marson B M, Tokish J T. The effect of a tourniquet on intraoperative patellofemoral tracking during total knee arthroplasty.  J Arthroplasty. 1999;  14 197-199
    CrossrefPubMedGoogle Scholar
  • 28 Mohler L R, Pedowitz R A, Lopez M A, Gershuni D H. Effects of tourniquet compression on neuromuscular function.  Clin Orthop. 1999;  359 213-220
    PubMedGoogle Scholar
  • 29 Mylod A G, France M P. et al . Perioperative blood loss associated with total knee arthroplasty.  J Bone Joint Surg [Am]. 1990;  72 1010-1012
    PubMedGoogle Scholar
  • 30 Newman J H, Jackson J P, Waugh W. Timing of tourniquet removal after knee replacement.  J R Soc Med. 1979;  72 492-494
    PubMedGoogle Scholar
  • 31 Page M H, Shepard B D, Harrison J M. Reduction of blood loss in knee arthroplasty.  Aust N Z J Surg. 1981;  54 141-144
    PubMedGoogle Scholar
  • 32 Pattison E, Protheroe K, Pringle R M. et al . Reduction in haemoglobin after knee joint surgery.  Ann Rheum Dis. 1973;  32 582-584
    PubMedGoogle Scholar
  • 33 Pedowitz R A. Tourniquet-induced neuromuscular injury. A recent review of rabbit and clinical experiments.  Acta Orthop Scand Suppl. 1991;  245 1-33
    PubMedGoogle Scholar
  • 34 Peter V K, Radford M, Matthews M G. Re- transfusion of autologous blood from wound drains: the means for reducing transfusion requirements in total knee arthroplasty.  Knee. 2001;  8 321-323
    CrossrefPubMedGoogle Scholar
  • 35 Sapega A A, Heppenstall R B, Chance B, Park Y S, Sokolow D. Optimizing tourniquet application and release times in extremity surgery: a biochemical and ultrastructural study.  J Bone Joint Surg [Am]. 1985;  67 303-314
    PubMedGoogle Scholar
  • 36 Saunders K C, Louis D, Weingarden S I, Waylonis G W. Effect of tourniquet time on postoperative quadriceps function.  Clin Orthop. 1979;  143 194-199
    PubMedGoogle Scholar
  • 37 Tetro A M, Rudan J F. The effects of a pneumatic tourniquet on blood loss in total knee arthroplasty.  Can J Surg. 2001;  44 33-38
    PubMedGoogle Scholar
  • 38 Vandenbussche E, Duranthon L D, Couturier M, Pidhorz L, Augereau B. The effect of tourniquet use in total knee arthroplasty.  Int Orthop. 2002;  26 306-309
    CrossrefPubMedGoogle Scholar
  • 39 Wakankar H M, Nicholl J E, Koka R, D'Arcy J C. The tourniquet in total knee arthroplasty. A prospective, randomised study.  J Bone Joint Surg [Br]. 1999;  81 30-33
    PubMedGoogle Scholar
  • 40 Wauke K, Nagashima M, Kato N, Ogawa R, Yoshino S. Comparative study between thromboembolism and total knee arthroplasty with or without tourniquet in rheumatoid arthritis patients.  Arch Orthop Trauma Surg. 2002;  122 442-446
    CrossrefPubMedGoogle Scholar
  • 41 Webb J M, Williams D, Ivory J P, Day S, Williamson D M. The use of cold compression dressings after total knee replacement: a randomized controlled trial.  Orthopedics. 1998;  21 59-61
    PubMedGoogle Scholar
  • 42 Widman J, Isacson J. Surgical hemostasis after tourniquet release does not reduce blood loss in knee replacement. A prospective randomized study of 81 patients.  Acta Orthop Scand. 1999;  70 268-270
    PubMedGoogle Scholar
  • 43 Wittmann F W, Ring P A. Blood loss associated with ring uncemented total knee replacement: Comparison between continuous and intermittent suction drainage.  J R Soc Med. 1984;  77 556-558
    PubMedGoogle Scholar

Dr. med. A. Schuh

Orthopädische Klinik Rummelsberg

Rummelsberg 71

90592 Schwarzenbruck

Phone: 0 91 28/50-33 33

Fax: 0 91 28/50-31 50

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