Surgery without tourniquet may prove advantageous vs tourniquet use
Orthopedics Today reports on the presentation by Jose A. Rodriguez, MD, hip and knee surgeon at HSS, during the Current Concepts in Joint Replacement Winter meeting about tourniquet use during total knee arthroplasty (TKA) surgery.
While tourniquet use has its advantages, there are considerations. Dr. Rodriguez explained, “We use it [tourniquet] because it works. It gives you a nice, clean surgical field, less blood loss and reproducible cement technique, and this has been my practice for 20 years.” Dr. Rodriguez added, “But let’s be clear: there are downsides, whether it is tissue ischemia, direct pressure damage or the embolic load that occurs with tourniquet release.”
While Dr. Rodriguez found a maximum drop in hemoglobin and a slightly higher hematocrit in his patients with limited tourniquet use, on closer examination he found non-statistically significant increases in pulmonary embolism, as well as stiffness that required manipulation. “Nerve damage has also been associated with tourniquet use for long periods of time,” said Dr. Rodriguez.
Dr. Rodriguez advised surgeons should have anesthesiologists provide a systolic blood pressure of less than 90 mm Hg and most of the surgery should be performed with the knee in flexion when a tourniquet is not used. When using cement, irrigation should be performed both before and after the cement is mixed. “We use the suction at 90° and it takes out a lot of the blood and fatty contents quite effectively allowing an appropriate and reproducible cement interdigitation to be achieved,” cited Dr. Rodriguez. “I would suggest that using this technique, you can get reproducible cement mantles just about every single time with no difference - tourniquet vs. [no] tourniquet.”
Read the full article at Healio.com.