PMID- 31965906
OWN - NLM
STAT- MEDLINE
DCOM- 20201221
LR  - 20201221
IS  - 2309-4990 (Electronic)
IS  - 1022-5536 (Linking)
VI  - 28
IP  - 1
DP  - 2020 Jan-Apr
TI  - Effects of tourniquet application on enhanced recovery after surgery (ERAS) and 
      ischemia-reperfusion post-total knee arthroplasty: Full- versus second 
      half-course application.
PG  - 2309499019896026
LID - 10.1177/2309499019896026 [doi]
AB  - PURPOSE: Pneumatic tourniquets are used in total knee arthroplasty (TKA) for 
      surgical field visualization and improved cementation; however, their use is 
      controversial. This study aimed to assess the effects of tourniquet application 
      on enhanced recovery post-TKA. METHODS: A prospective randomized single-blinded 
      trial assessed tourniquet's effects on postoperative pain, swelling, and early 
      outcome in TKA. One-hundred and two patients with knee osteoarthritis were 
      randomized to full-course (FC) and second half-course (SHC) application (n = 
      51/group). Tumor necrosis factor-alpha (TNF-alpha), C-C motif chemokine ligand 
      2(CCL-2), pentraxin-3 (PTX-3), prostaglandin E-2 (PGE-2), superoxide dismutase-1 
      (SOD-1), and myoglobin (Mb) were assessed by enzyme-linked immunosorbent assay, 
      while the visual analog scale (VAS), range of motion (ROM), and thigh 
      circumference growth rate were recorded. RESULTS: Average tourniquet duration 
      significantly differed between the SHC (37.5 +/- 5.1 min) and FC (66.4 +/- 7.2 min) 
      groups (p < 0.01); VAS and thigh circumference growth rate in the SHC group were 
      much lower compared with the FC group, while ROM was higher within 48 h of 
      tourniquet removal (p < 0.01). Blood TNF-alpha, PTX3, CCL2, PGE2, SOD-1, and Mb were 
      lower in the SHC group than the FC group (p < 0.01). Additionally, intraoperative 
      blood loss was significantly elevated in the SHC group than the FC group (p < 
      0.01), with lower postoperative blood loss in the drain (p = 0.001). 
      Postoperative drainage volume was reduced in the SHC group compared with the FC 
      group (p < 0.01); five and two patients in the FC and SHC groups required blood 
      transfusion, respectively (p = 0.025). Hospital stay tended to be shorter in the 
      SHC group (p = 0.023), and no tourniquet-related complications were recorded. 
      CONCLUSION: Improved therapeutic outcome was observed in the SHC group, 
      indicating patients should routinely undergo TKA with SHC tourniquet application.
FAU - Cao, Qinggang
AU  - Cao Q
AUID- ORCID: 0000-0001-8141-5328
AD  - Department of Orthopaedic Surgery, Jinling Hospital, Nanjing, China.
FAU - He, Zhiwei
AU  - He Z
AD  - Department of Orthopaedic Surgery, Jinling Hospital, Nanjing, China.
FAU - Fan, Yongfei
AU  - Fan Y
AD  - Department of Orthopaedic Surgery, Jinling Hospital, Nanjing, China.
FAU - Meng, Jia
AU  - Meng J
AD  - Department of Orthopaedic Surgery, Jinling Hospital, Nanjing, China.
FAU - Yuan, Tao
AU  - Yuan T
AD  - Department of Orthopaedic Surgery, Jinling Hospital, Nanjing, China.
FAU - Zhao, Jianning
AU  - Zhao J
AD  - Department of Orthopaedic Surgery, Jinling Hospital, Nanjing, China.
FAU - Bao, Nirong
AU  - Bao N
AD  - Department of Orthopaedic Surgery, Jinling Hospital, Nanjing, China.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - J Orthop Surg (Hong Kong)
JT  - Journal of orthopaedic surgery (Hong Kong)
JID - 9440382
SB  - IM
MH  - Aged
MH  - Arthroplasty, Replacement, Knee/*adverse effects
MH  - Blood Loss, Surgical/*prevention & control
MH  - China/epidemiology
MH  - *Enhanced Recovery After Surgery
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Length of Stay
MH  - Male
MH  - Middle Aged
MH  - Operative Time
MH  - Osteoarthritis, Knee/*surgery
MH  - Postoperative Hemorrhage/*prevention & control
MH  - Prospective Studies
MH  - Range of Motion, Articular/physiology
MH  - Reperfusion Injury/*epidemiology/etiology
MH  - Single-Blind Method
MH  - *Tourniquets
OTO - NOTNLM
OT  - pain
OT  - swelling
OT  - total knee arthroplasty
OT  - tourniquet
EDAT- 2020/01/23 06:00
MHDA- 2020/12/22 06:00
CRDT- 2020/01/23 06:00
PHST- 2020/01/23 06:00 [entrez]
PHST- 2020/01/23 06:00 [pubmed]
PHST- 2020/12/22 06:00 [medline]
AID - 10.1177/2309499019896026 [doi]
PST - ppublish
SO  - J Orthop Surg (Hong Kong). 2020 Jan-Apr;28(1):2309499019896026. doi: 
      10.1177/2309499019896026.