Skip to main content
SpringerLink
Log in

Bipolar Sealers and Tourniquet Use Have Similar Outcomes in Total Knee Arthroplasty

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

The data used in this study are from the authors’ institution and are available from the corresponding author, RS, upon reasonable request.

References

  1. Stokes, M. E., Ye, X., Shah, M., Mercaldi, K., Reynolds, M. W., Rupnow, M. F. T., et al. (2011). Impact of bleeding-related complications and/or blood product transfusions on hospital costs in inpatient surgical patients. BMC Health Services Research. https://doi.org/10.1186/1472-6963-11-135

    Article  PubMed  PubMed Central  Google Scholar 

  2. Park, J. H., Rasouli, M. R., Mortazavi, S. M. J., Tokarski, A. T., Maltenfort, M. G., & Parvizi, J. (2013). Predictors of perioperative blood loss in total joint arthroplasty. J Bone Jt Surg Ser A. https://doi.org/10.2106/JBJS.L.01335

    Article  Google Scholar 

  3. Hart, A., Khalil, J. A., Carli, A., Huk, O., Zukor, D., & Antoniou, J. (2014). Blood transfusion in primary total hip and knee arthroplasty. Incidence, risk factors, and thirty-day complication rates. J Bone Jt Surg Am. https://doi.org/10.2106/JBJS.N.00077

    Article  Google Scholar 

  4. Cai, D. F., Fan, Q. H., Zhong, H. H., Peng, S., & Song, H. (2019). The effects of tourniquet use on blood loss in primary total knee arthroplasty for patients with osteoarthritis: a meta-analysis. Journal of Orthopaedic Surgery and Research. https://doi.org/10.1186/s13018-019-1422-4

    Article  PubMed  PubMed Central  Google Scholar 

  5. Huang, Z., Ma, J., Shen, B., Yang, J., Zhou, Z., Kang, P., et al. (2015). Use of a bipolar blood-sealing system during total joint arthroplasty. Orthopedics. https://doi.org/10.3928/01477447-20151119-07

    Article  PubMed  Google Scholar 

  6. Liu, Y., Si, H., Zeng, Y., Li, M., Xie, H., & Shen, B. (2020). More pain and slower functional recovery when a tourniquet is used during total knee arthroplasty. Knee Surg Sport Traumatol Arthrosc. https://doi.org/10.1007/s00167-019-05617-w

    Article  Google Scholar 

  7. Ajnin, S., & Fernandes, R. (2020). Reduced length of stay and faster recovery after total knee arthroplasty without the use of tourniquet. J Clin Orthop Trauma. https://doi.org/10.1016/j.jcot.2019.08.016

    Article  PubMed  Google Scholar 

  8. Zeh, A., Messer, J., Davis, J., Vasarhelyi, A., & Wohlrab, D. (2010). The aquamantys system-an alternative to reduce blood loss in primary total hip arthroplasty? Journal of Arthroplasty. https://doi.org/10.1016/j.arth.2009.10.008

    Article  PubMed  Google Scholar 

  9. Kamath, A. F., Austin, D. C., Derman, P. B., Clement, R. C., Garino, J. P., & Lee, G. C. (2014). Saline-coupled bipolar sealing in simultaneous bilateral total knee arthroplasty. Clinics in Orthopedic Surgery. https://doi.org/10.4055/cios.2014.6.3.298

    Article  PubMed  PubMed Central  Google Scholar 

  10. Pfeiffer, M., Bräutigam, H., Draws, D., & Sigg, A. (2005). A new bipolar blood sealing system embedded in perioperative strategies vs. a conventional regimen for total knee arthroplasty: Results of a matched-pair study. German Medical Science, 3:Doc10

  11. Marulanda, G.A., Ragland, P.S., Seyler, T.M., & Mont, M.A. (2005). Reductions in blood loss with use of a bipolar sealer for hemostasis in primary total knee arthroplasty. Surgical Technology International, 14, 281–286

  12. Pasqualotto, S., Demey, G., Dejour, D., Michelet, A., Nover, L., & Saffarini, M. (2020). Bipolar sealers do not improve blood loss or functional outcomes of primary total knee arthroplasty. The Journal of Knee Surgery. https://doi.org/10.1055/s-0038-1676516

    Article  PubMed  Google Scholar 

  13. Marulanda, G.A., Krebs, V.E., Bierbaum, B.E., et al (2009). Hemostasis using a bipolar sealer in primary unilateral total knee arthroplasty. American Journal of Orthopedics (Belle Mead NJ), 38, E179-83

  14. Li, H-Z., Li, X-Q., Zhao, G-Z., et al (2017). The efficacy of bipolar sealer for blood loss control after total knee arthroplasty: A meta-analysis. International Journal of Clinical and Experimental Medicine, 10, 1778–1787

  15. Wen, L. J., Shuo, M. Y., & Kun, X. L. (2019). Postoperative pain management in total knee arthroplasty. Orthopaedic Surgery, 11, 755–761. https://doi.org/10.1111/os.12535

    Article  Google Scholar 

  16. Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain-United States, 2016. Journal of the American Medical Association, 315, 1624–1645. https://doi.org/10.1001/jama.2016.1464

    Article  CAS  PubMed  Google Scholar 

  17. Lappin, R. (2016). CDC issues new opioid prescribing guideline. Emergency Medicine, 48, 150–151. https://doi.org/10.15585/mmwr.rr6501e1er

    Article  Google Scholar 

  18. Chen, X., Yang, W., & Wang, X. (2019). Is bipolar sealer superior than standard electrocautery for blood loss control after primary total knee arthroplasty: A meta-analysis. Medicine (Baltimore) 98,e17762. https://doi.org/10.1097/MD.0000000000017762

  19. Goel, R., Rondon, A.J., Sydnor, K., et al (2019). Tourniquet Use Does Not Affect Functional Outcomes or Pain after Total Knee Arthroplasty: A Prospective, Double-Blinded, Randomized Controlled Trial. The Journal of Bone & Joint Surgery American Volume, 101, 1821–1828. https://doi.org/10.2106/JBJS.19.00146

  20. McCarthy, D. E., Hu, S.Y., & Abdulkarim, A. (2019). Does Tourniquet Use in TKA Increase Postoperative Pain? A Systematic Review and Meta-analysis. Clinical Orthopaedics and Related Research, 477, 547–558. https://doi.org/10.1097/CORR.0000000000000572

  21. Goel, R., Rondon, A. J., Sydnor, K., et al. (2019). Tourniquet use does not affect functional outcomes or pain after total knee arthroplasty: a prospective, double-blinded, randomized controlled trial. J Bone Jt Surg Am, 101, 1821–1828. https://doi.org/10.2106/JBJS.19.00146

    Article  Google Scholar 

  22. Zak, S. G., Yeroushalmi, D., Long, W. J., Meftah, M., Schnaser, E., & Schwarzkopf, R. (2021). Does the use of a tourniquet influence outcomes in total knee arthroplasty: a randomized controlled trial. Journal of Arthroplasty. https://doi.org/10.1016/j.arth.2021.02.068

    Article  PubMed  Google Scholar 

  23. Hung, M., Bounsanga, J., Voss, M. W., & Saltzman, C. L. (2018). Establishing minimum clinically important difference values for the patient-reported outcomes measurement information system physical function, hip disability and osteoarthritis outcome score for joint reconstruction, and knee injury and osteoarthritis outcome score for joint reconstruction in orthopaedics. World J Orthop, 9(3), 41–49. https://doi.org/10.5312/wjo.v9.i3.41

    Article  PubMed  PubMed Central  Google Scholar 

  24. Gandek, B., Roos, E. M., Franklin, P. D., & Ware, J. E. (2019). A 12-item short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-12): tests of reliability, validity and responsiveness. Osteoarthritis and Cartilage, 27, 762–770. https://doi.org/10.1016/J.JOCA.2019.01.011

    Article  CAS  PubMed  Google Scholar 

  25. Eckhard, L., Munir, S., Wood, D., et al. (2021). The KOOS-12 shortform shows no ceiling effect, good responsiveness and construct validity compared to standard outcome measures after total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy, 29, 608–615. https://doi.org/10.1007/S00167-020-05904-X

    Article  PubMed  Google Scholar 

Download references

Funding

There is no funding source for this paper.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA

    Stephen G. Zak, Nishanth Muthusamy, Chelsea Sicat, James Slover & Ran Schwarzkopf

Authors
  1. Stephen G. Zak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nishanth Muthusamy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chelsea Sicat
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James Slover
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ran Schwarzkopf
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Mr. SZ: writing original draft, writing review and editing. Mr. NM: writing—review and editing. Ms. CS: formal analysis and investigation. Dr. JS: conceptualization, writing—review and editing. Dr. RS: supervision, writing—review and editing.

Corresponding author

Correspondence to Ran Schwarzkopf.

Ethics declarations

Conflict of Interest

One of more authors is a paid consultant for Horizon Pharma, Intelijoint and Smith & Nephew; receives royalties from Smith & Nephew; own stock in Gauss surgical and Intelijoint; and received research support from Smith & Nephew.

Ethical Approval

This study has obtained all required IRB and ethical approval at our institution.

Informed Consent

This study is a retrospective review in which patients were subject to their normal standard of care. No individual data are included within this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zak, S.G., Muthusamy, N., Sicat, C. et al. Bipolar Sealers and Tourniquet Use Have Similar Outcomes in Total Knee Arthroplasty. JOIO 56, 1745–1750 (2022). https://doi.org/10.1007/s43465-022-00670-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43465-022-00670-z

Keywords

Search

Navigation