Title Comparison of three tourniquet application methods in primary total knee arthroplasty surgery /
Translation of Title Trijų kraujotakos sumažinimo metodų palyginimas atliekant planinį cementinį kelio sąnario endoprotezavimą.
Authors Kvederas, Giedrius
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Pages 54
Keywords [eng] total knee arthroplasty ; tourniquet ; blood loss ; functional outcomes ; individualized fluid therapy
Abstract [eng] The optimal timing of pneumatic lower limb tourniquet application during primary elective total knee arthroplasty surgery (TKA) is a matter of debate. 132 patients who undergo TKA were prospectively randomized into one of the 4 groups, and 120 of these patients completed the study. The tourniquet was inflated just before incision and deflated after the hardening of the cement for 30 patients (Group 1), it was inflated just before cement application and deflated after its hardening for another 30 patients (Group 2), and it was inflated before incision and deflated after the last suture of the skin for a further 30 patients (Group 3). The Group 4 received fluids at the discretion of an attending physician (standard of care). Group 1, 2 and 3 were given the same regimen but it was supplemented by a revGDT (revised Goal directed therapy) algorithm before the TKA and 24 h later. Fit-to-discharge criteria and six methods for calculating estimated blood loss were used. The estimated blood loss in Group 2 was higher than in Group 1 and 3. Group 1 was better fit to discharge than Group 3 and Group 4. Inflation of an automatic pneumatic lower limb tourniquet before skin incision and its deflation after hardening of cement tends to give better outcomes in TKA patients during six postoperative days. The estimated blood loss was highest when the tourniquet was inflated just before cement application and deflated after its hardening. Perioperative revGDT enhanced recovery after TKA.
Dissertation Institution Vilniaus universitetas.
Type Summaries of doctoral thesis
Language English
Publication date 2015