DOS Afhandlingsdatabase

Titel på arbejdetThe Value of Tourniquet: Implant Fixation and Rehabilitation in Cemented TKA
NavnAshir Ejaz
Afdeling / StedDept. of Orthopaedics, Aalborg University Hospital
UniversitetAalborg University
  • Hip and knee surgery
Abstract / Summary

Pneumatic tourniquets are widely used in orthopedic extremity
surgery. Especially in TKA they have an established
place, ensuring surgical overview in a bloodless field and decreasing
bleeding. Despite knowing that tourniquet causes
ischemia and soft tissue damage surgeons still carry on using
them and are often not conscious of the exact extent of
ischemia and damage tourniquets can inflict. One of the
main reasons for using a tourniquet in TKA is theoretical
i.e., assuming that the quality of cementation is enhanced,
thereby improving implant fixation.
Studies using RSA have shown early tibial migration is associated
with increased risk of short- and long-term revision.
Due to the special loading kinematics of the tibial component
in the TKA procedure, good cementation is of vital importance,
and it is of great concern to surgeons if this is not
achieved, especially if a tourniquet has not been used.
!e advantages should always be balanced against the risks
involved in tourniquet use. !e advantages have been considered
to include absence of intraoperative bleeding, better
surgical overview and concurrently a reduction of surgical
time and better cementation of the components. !e disadvantages
include nerve palsy, vascular and skeletal tissue injuries,
severe thigh pain and swelling, and diminished range
of motion. Cases of impaired cardio-respiratory function,
pulmonary thromboembolism and rhabdomyolysis induced
by tourniquet use have all been reported. Due to hypoxia and
impaired postoperative tissue perfusion, wound healing disorders
and early infections have been attributed to the use of
a tourniquet.
!e aim of this study was to investigate in a randomized controlled
setup, in which patients were allocated to a tourniquet
group and a non-tourniquet group, whether the absence of a
tourniquet during cemented TKA would affect:
1. The clinical outcomes regarding rehabilitation (KOOS)
and knee range of motion
2. Thee ischemic conditions in so$ tissue
3. Implant fixation

Andre oplysninger

Download afhandling