Introduction

The use of tourniquets and bipolar sealers are effective methods of hemostasis during total knee arthroplasty (TKA). However, their effect on perioperative patient outcomes is unknown. The purpose of this study is to compare the efficacy of tourniquet-less, tourniquet-less with use of a bipolar sealer, and tourniquet use on postoperative pain and surgical outcomes following TKA.

Methods

A retrospective study of prospectively collected data of 120 primary TKA cases was conducted at an urban academic hospital. Primary outcomes were visual analog scale (VAS) scores and opioid consumption (in morphine milligram equivalents). Demographics, length of stay (LOS), perioperative complications, and change in Knee Injury and Osteoarthritis Outcome Score (ΔKOOS) were also collected. Patients were divided into cohorts based on the use of tourniquet-less with bipolar sealer (TRLB) (n = 40), tourniquet (TR) (n = 40), or tourniquet-less (TRL) (n = 40).

Results

There were no differences in demographic data between each cohort. TRLB, TR and TRL had similar LOS (2.68 ± 1.63 vs 2.29 ± 1.27 vs 2.36 ± 1.42 days; p = 0.472) and VAS pain score on postoperative day 1 (4.68 vs 3.74 vs 3.63; p = 0.209). There were also no differences in opioid consumption at 2 weeks (p = 0.903), 1 month (p = 0.973), 3 months (p = 0.983), or 5 months (p = 0.983) post-operatively. TRLB and TR had comparable improvement in ΔKOOS from baseline to 12 weeks post-operatively (Δ16.58 ± 8.47 vs Δ23.92 ± 14.60; p = 0.254). Compared to the ΔKOOS of TRL (Δ5.19 ± 2.59), TRLB and TR had clinically and statistically greater ΔKOOS improvements (p = 0.009; p = 0.001). The TRL cohort also had a higher readmission rate than TRLB and TR (15% vs 0% vs 5%, p = 0.025).

Conclusion

Our findings demonstrate that both bipolar sealer and tourniquet use in TKA are associated with similar postoperative pain levels and LOS in comparison to tourniquet-less only TKA. However, bipolar sealer and tourniquet use may lead to better longer term improvement such as greater PRO score improvement and fewer readmissions.

中文翻译：

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双极封闭器和止血带的使用在全膝关节置换术中具有相似的结果

介绍

使用止血带和双极封闭器是全膝关节置换术 (TKA) 期间有效的止血方法。然而，它们对围手术期患者结局的影响尚不清楚。本研究的目的是比较无止血带、无止血带使用双极封闭器以及使用止血带对 TKA 术后疼痛和手术结果的疗效。

方法

对某城市专科医院前瞻性收集的 120 例原发 TKA 病例的数据进行回顾性研究。主要结果是视觉模拟量表（VAS）评分和阿片类药物消耗量（以吗啡毫克当量计）。还收集了人口统计数据、住院时间 (LOS)、围手术期并发症以及膝关节损伤和骨关节炎结果评分 (ΔKOOS) 的变化。根据使用双极封闭器无止血带 (TRLB) ( n  = 40)、止血带 (TR) ( n  = 40) 或无止血带 (TRL) ( n  = 40) ，将患者分为不同组。

结果

每个队列之间的人口统计数据没有差异。TRLB、TR 和 TRL 的 LOS（2.68 ± 1.63 vs 2.29 ± 1.27 vs 2.36 ± 1.42 天； p  = 0.472）和术后第 1 天的 VAS 疼痛评分相似（4.68 vs 3.74 vs 3.63； p  = 0.209）。术后 2 周 ( p  = 0.903)、1 个月 ( p  = 0.973)、3 个月 ( p  = 0.983) 或 5 个月 ( p  = 0.983) 时阿片类药物的消耗量也没有差异。TRLB 和 TR 从基线到术后 12 周的 ΔKOOS 改善相当（Δ16.58 ± 8.47 对比 Δ23.92 ± 14.60；p  = 0.254）。与 TRL 的 ΔKOOS (Δ5.19 ± 2.59) 相比，TRLB 和 TR 在临床和统计学上具有更大的 ΔKOOS 改善 ( p  = 0.009; p  = 0.001)。TRL 队列的再入院率也高于 TRLB 和 TR（15% vs 0% vs 5%，p  = 0.025）。

结论

我们的研究结果表明，与仅不使用止血带的 TKA 相比，在 TKA 中使用双极封闭器和止血带与相似的术后疼痛水平和 LOS 相关。然而，双极封闭剂和止血带的使用可能会带来更好的长期改善，例如更大的 PRO 分数改善和更少的再入院。