Effect of tourniquet use on perioperative blood loss in total knee arthroplasty in patients with rheumatoid arthritis
Wang Hao1, 2, Ma Chenghao1, Qin Zuohai1, Zhou Haibo1, 2, Ding Haoyuan1, 2, Han Dapeng1, Nie Zhixing1, Pan Peijun1, Gao Chenxin1, Ouyang Guilin1, 3
1Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200052, China; 2Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; 3Arthritis Research Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai 200050, China
Abstract: BACKGROUND: Without using a tourniquet in total knee arthroplasty can decrease perioperative blood loss. However, patients diagnosed with rheumatoid arthritis may affect the perioperative blood loss in total knee arthroplasty, especially in hidden blood loss.
OBJECTIVE: To evaluate the effect of tourniquet in patients with rheumatoid arthritis on perioperative blood loss in total knee arthroplasty.
METHODS: The clinical data of 80 patients diagnosed with rheumatoid arthritis undergoing unilateral total knee arthroplasty between January 2016 and December 2021 in the Department of Joint Surgery of Shanghai Guanghua Hospital of Integrated Chinese and Western Medicine were retrospectively analyzed. All patients underwent total knee arthroplasty under general anesthesia; 41 patients (control group) received total knee arthroplasty with a tourniquet while 39 patients (trial group) received total knee arthroplasty without a tourniquet. The total blood loss, intraoperative blood loss, overt blood loss, hidden blood loss, percentage of hidden blood loss, blood transfusion rate, operation time, limb swelling ratio at postoperative 3 days, wound dressing changing frequency, and delayed incision healing were recorded and compared between the two groups.
RESULTS AND CONCLUSION: (1) The percentage of hidden blood loss was significantly lower in the trial group than that in the control group (P < 0.05). The intraoperative blood loss and operation time in the trial group were significantly higher than those in the control group (P < 0.05). There were no significant differences in total blood loss, hidden blood loss, overt blood loss, or transfusion rate between two groups (P > 0.05). (2) The postoperative limb swelling ratio in the trial group was significantly lower than that in the control group (P < 0.05). There were no significant differences in wound dressing changing frequency or delayed incision healing between the two groups (P > 0.05). (3) It is indicated that without using a tourniquet in patients with rheumatoid arthritis undergoing total knee arthroplasty does not increase the perioperative blood loss or hidden blood loss, and also decreases the postoperative limb swelling.
Key words: total knee arthroplasty, tourniquet, rheumatoid arthritis, perioperative blood loss, hidden blood loss, knee joint