Comparing Sequential vs Simultaneous Tourniquet Inflation in Bilateral Total Knee Arthroplasty
Background: There is little evidence on outcomes of tourniquet use during bilateral total knee arthroplasty (BTKA). Tourniquet use in BTKA effects postoperative outcomes and efficiency inside the operating room. This study evaluates the safety and efficacy of simultaneous tourniquet inflation in BTK...
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doaj-8ff62e9cf80e41d89f75161ae06bf3582021-05-16T04:23:59ZengElsevierArthroplasty Today2352-34412021-04-018132137Comparing Sequential vs Simultaneous Tourniquet Inflation in Bilateral Total Knee ArthroplastyPaul Enns, MD0Simon Garceau, MD, FRCSC1Greg Teo, MD2Simcha Pollock, PhD3William J. Long, MD, FRCSC4NYU Langone, Division of Orthopedics, Adult Joint Reconstruction, New York, NY, USA; Insall-Scott-Kelly Institute, New York, NY, USANYU Langone, Division of Orthopedics, Adult Joint Reconstruction, New York, NY, USA; Insall-Scott-Kelly Institute, New York, NY, USAInsall-Scott-Kelly Institute, New York, NY, USASt. John’s University, New York, NY, USANYU Langone, Division of Orthopedics, Adult Joint Reconstruction, New York, NY, USA; Insall-Scott-Kelly Institute, New York, NY, USA; Corresponding author. NYU Langone, Division of Orthopedic Surgery, 301 E 17th Street, Suite 1402, New York, NY 10003, USA. Tel.: +1 646 293 7515.Background: There is little evidence on outcomes of tourniquet use during bilateral total knee arthroplasty (BTKA). Tourniquet use in BTKA effects postoperative outcomes and efficiency inside the operating room. This study evaluates the safety and efficacy of simultaneous tourniquet inflation in BTKA. Materials and Methods: A retrospective review was performed on BTKA patients between March 2013 and May 2018. A total of 285 patients were divided into 2 cohorts. Patients in the simultaneous cohort had concomitant elevation of both tourniquets, but the sequential cohort did not. Perioperative variables were collected, and postoperative complications were tracked for a minimum of 90 days. Patients followed a uniform postoperative protocol. Complications were grouped by category to increase statistical power and compared using a noninferiority test. “Clinically noninferior” was defined as a margin ≤5%. Results: The simultaneous cohort had significantly (P < .05) higher American Society of Anesthesiologists class and smokers. Tourniquet time, delta hemoglobin, and surgical time were significantly lower. For the complication categories of “Any Thrombotic Event”, “Respiratory”, and “Soft Tissue/Wound”, the difference in occurrence rates was no more than 2.8%, 2.8%, and 5.2% between cohorts, respectively. The “Cardiovascular (non-MI)” group was no more than 9.3% different, that is, authors are 95% confident that 3 of 4 complication categories meet the clinically noninferior threshold. Conclusion: The study demonstrates the noninferiority of simultaneous as compared to sequential tourniquet inflation in BTKA. Patients with cardiac history may need sequential inflation or staged TKA. The information presented in the study assists surgeons in safely and efficiently performing BTKA.http://www.sciencedirect.com/science/article/pii/S2352344121000236TourniquetBilateral total knee arthroplastyTourniquet inflationSystemic complications |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Paul Enns, MD Simon Garceau, MD, FRCSC Greg Teo, MD Simcha Pollock, PhD William J. Long, MD, FRCSC |
spellingShingle |
Paul Enns, MD Simon Garceau, MD, FRCSC Greg Teo, MD Simcha Pollock, PhD William J. Long, MD, FRCSC Comparing Sequential vs Simultaneous Tourniquet Inflation in Bilateral Total Knee Arthroplasty Arthroplasty Today Tourniquet Bilateral total knee arthroplasty Tourniquet inflation Systemic complications |
author_facet |
Paul Enns, MD Simon Garceau, MD, FRCSC Greg Teo, MD Simcha Pollock, PhD William J. Long, MD, FRCSC |
author_sort |
Paul Enns, MD |
title |
Comparing Sequential vs Simultaneous Tourniquet Inflation in Bilateral Total Knee Arthroplasty |
title_short |
Comparing Sequential vs Simultaneous Tourniquet Inflation in Bilateral Total Knee Arthroplasty |
title_full |
Comparing Sequential vs Simultaneous Tourniquet Inflation in Bilateral Total Knee Arthroplasty |
title_fullStr |
Comparing Sequential vs Simultaneous Tourniquet Inflation in Bilateral Total Knee Arthroplasty |
title_full_unstemmed |
Comparing Sequential vs Simultaneous Tourniquet Inflation in Bilateral Total Knee Arthroplasty |
title_sort |
comparing sequential vs simultaneous tourniquet inflation in bilateral total knee arthroplasty |
publisher |
Elsevier |
series |
Arthroplasty Today |
issn |
2352-3441 |
publishDate |
2021-04-01 |
description |
Background: There is little evidence on outcomes of tourniquet use during bilateral total knee arthroplasty (BTKA). Tourniquet use in BTKA effects postoperative outcomes and efficiency inside the operating room. This study evaluates the safety and efficacy of simultaneous tourniquet inflation in BTKA. Materials and Methods: A retrospective review was performed on BTKA patients between March 2013 and May 2018. A total of 285 patients were divided into 2 cohorts. Patients in the simultaneous cohort had concomitant elevation of both tourniquets, but the sequential cohort did not. Perioperative variables were collected, and postoperative complications were tracked for a minimum of 90 days. Patients followed a uniform postoperative protocol. Complications were grouped by category to increase statistical power and compared using a noninferiority test. “Clinically noninferior” was defined as a margin ≤5%. Results: The simultaneous cohort had significantly (P < .05) higher American Society of Anesthesiologists class and smokers. Tourniquet time, delta hemoglobin, and surgical time were significantly lower. For the complication categories of “Any Thrombotic Event”, “Respiratory”, and “Soft Tissue/Wound”, the difference in occurrence rates was no more than 2.8%, 2.8%, and 5.2% between cohorts, respectively. The “Cardiovascular (non-MI)” group was no more than 9.3% different, that is, authors are 95% confident that 3 of 4 complication categories meet the clinically noninferior threshold. Conclusion: The study demonstrates the noninferiority of simultaneous as compared to sequential tourniquet inflation in BTKA. Patients with cardiac history may need sequential inflation or staged TKA. The information presented in the study assists surgeons in safely and efficiently performing BTKA. |
topic |
Tourniquet Bilateral total knee arthroplasty Tourniquet inflation Systemic complications |
url |
http://www.sciencedirect.com/science/article/pii/S2352344121000236 |
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