Blood level changes in total knee arthroplasty with and without a tourniquet☆

Barros, Marco Felipe Francisco Honorato de; Ribeiro, Evandro Junior Christovam; Dias, Rafael Gomes

doi:10.1016/j.rboe.2017.10.001

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Revista Brasileira de Ortopedia

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ORIGINAL ARTICLE • Rev. bras. ortop. 52 (06) • Nov-Dec 2017 • https://doi.org/10.1016/j.rboe.2017.10.001 copy

Blood level changes in total knee arthroplasty with and without a tourniquet^☆ ☆ Paper developed at Hospital Regional de Presidente Prudente, Serviço de Ortopedia e Traumatologia, Presidente Prudente, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

To evaluate the difference between the total blood loss in patients undergoing primary total knee arthroplasty with and without the use of tourniquet.

METHODS:

A retrospective cohort study, with analysis of medical records of patients undergoing primary total knee arthroplasty in 2015, with and without the use of a tourniquet. Comparison was performed of hemoglobin (HB) and hematocrit (HT) variation in the complete blood count (CBC) during the pre- and post-operative period between the two groups.

RESULTS:

There were 117 patients undergoing primary total knee arthroplasty included, minimum age of 33 and maximum of 86 years, with a mean of 67 years. 64.1% of the surgeries used a tourniquet and 35.9% did not. The mean preoperative HB in Group 1 was 13.08 and 12.97 in Group 2 (p = 0.435). The mean postoperative HB in Group 1 was 11.64 and 10.93 in Group 2 (p = 0.016). The variation of HB in Group 1 was 1.44 and 2.04 in Group 2 (p = 0.025). The mean preoperative HT in Group 1 was 38.96 and 39.01 in Group 2 (p = 0.898). The mean postoperative HT in Group 1 was 34.47 and 32.19 in Group 2 (p = 0.005). The variation of HT in Group 1 was 4.49 and 6.82 in Group 2 (p = 0.001). A total of 21 patients received transfusions RCC (red cell concentrates), as a result of HB below 8 g/dL or clinical symptoms, respectively, representing seven of Group 1 (9.3% of total intra-group) and 14 of Group 2 (33.3% of total intra-group), with p = 0.001.

CONCLUSION:

In patients undergoing primary total knee arthroplasty using a tourniquet, a lower variance in the hematimetric indices was observed and fewer blood transfusions were necessary.

Keywords:
Knee replacement arthroplasty; Surgical blood loss; Blood transfusion; Tourniquets

Infectious risks	Noninfectious risks
Virus (e.g., human immunodeficiency virus)	Acute transfusional reaction
Bacteria (e.g., Staphilococcus aureus)	Late transfusional reactions
Parasites (e.g., malaria)	Febrile non-hemolytic reaction
Prions	Allergic reaction
	Acute transfusion-associated lung lesion
	Graft-versus-host disease
	Immunosuppression
	Posttransfusional Purpura
	Transfusion mistakes

Age	Gender	Side operated on	Used tourniquet	HB PRE	HB POS	HB variation	HT PRE	HT POS	HT variation
64	F	Right	Yes	3	10.6	2.4	39	31.4	7.60
74	F	Right	Yes	4.3	13.9	0.4	41.4	39.7	1.70
76	F	Right	Yes	11.1	12.8	-1.7	32.5	38.7	-6.20
79	F	Left	Yes	12.8	12	0.8	38.9	35.6	3.30
72	F	Left	Yes	13	11.8	1.2	36.8	33	3.80
68	F	Right	Yes	12.8	10.3	2.5	38	30.5	7.50
62	F	Left	Yes	12	10.5	1.5	35.7	30.7	5.00
71	F	Right	Yes	13.9	13.4	0.5	41	39.8	1.20
65	F	Right	Yes	13.3	10.6	2.7	38.7	32.2	6.50
47	M	Right	Yes	12.6	10.2	2.4	36.5	29.5	7.00
75	M	Left	Yes	14.8	14.7	0.1	42.5	42.2	0.30
72	F	Right	Yes	10.3	10.3	0	30.5	31.6	-1.10
68	F	Left	Yes	13.9	11.1	2.8	38.9	33.7	5.20
59	F	Right	Yes	13.6	12.5	1.1	42.7	36.5	6.20
60	F	Left	Yes	13.3	11.5	1.8	39.5	34.1	5.40
62	F	Right	Yes	14	10.9	3.1	41.9	33.1	8.80
69	M	Right	Yes	14.2	12.7	1.5	42.7	37.3	5.40
74	F	Left	Yes	12.3	11.9	0.4	36.9	35.7	1.20
66	M	Right	Yes	14.4	12.6	1.8	40.9	35.8	5.10
69	M	Left	Yes	15.2	14.5	0.7	44.8	41	3.80
60	M	Left	Yes	13.9	12.5	1.4	40	34.5	5.50
75	F	Right	Yes	11.9	11.5	0.4	34.6	33.5	1.10
64	F	Left	Yes	11.4	10.3	1.1	35.6	32.6	3.00
63	F	Left	Yes	14	13.4	0.6	40.4	38	2.40
71	M	Right	Yes	14.5	11.6	2.9	40.4	31.9	8.50
77	F	Right	Yes	13.9	12.6	1.3	40.3	36.8	3.50
52	F	Right	Yes	12.3	11.6	0.7	35.3	33.4	1.90
76	M	Right	Yes	12.9	12.1	0.8	41.1	39.3	1.80
59	F	Left	Yes	16.6	13.6	3	46.6	38.6	8.00
68	F	Right	Yes	13.1	12.5	0.6	38.2	32.1	6.10
71	F	Right	Yes	11.8	9.5^a	2.3	34.6	27	7.60
65	F	Left	Yes	12.2	12	0.2	35.9	33.8	2.10
72	F	Right	Yes	12.8	11.1	1.7	38	32.1	5.90
71	F	Left	Yes	13.7	12.5	1.2	41	37.2	3.80
74	F	Right	Yes	14	11.7	2.3	42	35.3	6.70
62	M	Left	Yes	15	12.4	2.6	44.4	37.1	7.30
69	F	Right	Yes	15.3	12.6	2.7	46.4	39	7.40
59	F	Left	Yes	11.4	10.4	1	33.7	32.3	1.40
70	F	Right	Yes	12.5	11	1.5	36.9	33.3	3.60
77	F	Right	Yes	13.5	11.1	2.4	40	33.3	6.70
59	F	Right	Yes	13	12	1	37.9	36.9	1.00
65	F	Right	Yes	13.5	10.5	3	41.3	33.2	8.10
66	F	Left	Yes	14.5	14.4	0.1	42.8	42.5	0.30
67	F	Left	Yes	13.9	11.4	2.5	42.1	35.6	6.50
53	F	Right	Yes	13.7	11	2.7	40.4	32.4	8.00
57	M	Right	Yes	11.5	10.2	1.3	34.8	30.4	4.40
71	F	Left	Yes	12	10.5	1.5	36.4	32.6	3.80
73	F	Right	Yes	12.1	11.5	0.6	36.4	30.2	6.20
66	F	Right	Yes	10.4	9.9	0.5	33.7	29.3	4.40
49	F	Left	Yes	10.5	8.9^a	1.6	35.5	30.8	4.70
69	M	Right	Yes	13.7	11.1	2.6	39.5	34	5.50
86	M	Right	Yes	12.7	12.1	0.6	38.7	37.9	0.80
65	M	Right	Yes	14.9	14.1	0.8	45.3	43.7	1.60
59	M	Right	Yes	13.3	12	1.3	38.7	35.9	2.80
63	M	Left	Yes	11.7	9.5^a	2.2	37.2	31	6.20
59	F	Right	Yes	10.6	9.5^a	1.1	32.5	30.2	2.30
66	F	Left	Yes	10.5	9.1^a	1.4	33.4	27.8	5.60
74	M	Right	Yes	12.5	11.4	1.1	37.3	34.1	3.20
64	M	Left	Yes	13	12.1	0.9	39.1	32.4	6.70
38	M	Right	Yes	15.5	14	1.5	46.7	42.3	4.40
78	M	Right	Yes	15.6	14.2	1.4	45.3	42.5	2.80
64	F	Left	Yes	14.3	13.9	0.4	41.7	38.3	3.40
80	F	Right	Yes	10.8	8.8^a	2	34.9	28.1	6.80
70	F	Right	Yes	12.7	11.4	1.3	37.3	33.6	3.70
82	F	Right	Yes	12.1	11.2	0.9	37.2	34	3.20
70	F	Left	Yes	12.9	11	1.9	38.6	32.6	6.00
59	F	Right	Yes	13.1	9.6^a	3.5	38.5	28.1	10.40
75	F	Left	Yes	12.3	10.4	1.9	36.3	29.3	7.00
72	F	Left	Yes	13.3	12.5	0.8	38.4	32	6.40
60	M	Right	Yes	14.3	13.4	0.9	43	37.4	5.60
39	F	Right	Yes	13.3	12.2	1.1	37.8	35.4	2.40
67	F	Left	Yes	12.3	10.6	1.7	36.3	31.3	5.00
70	F	Right	Yes	13.3	9.8	3.5	39.8	29.6	10.20
72	F	Left	Yes	12.4	12.2	0.2	39.4	38.3	1.10
62	F	Right	Yes	13.4	11.9	1.5	42.7	38.7	4.00
Average standard deviation				13.08 ± 1.32	11.64 ± 1.41	1.44 ± 0.96	38.96 ± 3.51	34.47 ± 3.89	4.49 ± 2.80

Age	Gender	Side operated on	Used tourniquet	HB PRE	HB POS	HB variation	HT PRE	HT POS	HT variation
75	M	Right	No	14.7	13.6	1.1	42.5	39.3	3.20
56	M	Right	No	14.8	11.4	3.4	42.3	33	9.30
64	F	Left	No	9.8	8.8^a	1	29.6	26.1	3.50
65	F	Right	No	11.8	10.5	1.3	36	32.1	3.90
69	F	Left	No	12.3	10.5	1.8	36.2	30.4	5.80
62	M	Right	No	13.5	12.4	1.1	40.2	36.5	3.70
71	F	Right	No	11.2	9.2^a	2	37	29.5	7.50
65	M	Right	No	16	11.6	4.4	46.5	33.8	12.70
33	F	Left	No	12.5	11.3	1.2	40	34.2	5.80
73	M	Left	No	14.8	13.7	1.1	49.9	38.1	11.80
82	F	Left	No	12.9	9.4^a	3.5	39.1	27.5	11.60
69	F	Right	No	10.5	9.2^a	1.3	30.8	27.2	3.60
76	F	Right	No	11	9.3^a	1.7	34.2	29.4	4.80
47	F	Right	No	15.8	13.4	2.4	44.5	38.5	6.00
47	F	Left	No	11.9	9.7^a	2.2	37.3	28.8	8.50
67	F	Right	No	13.9	9.5^a	4.4	39.9	27.3	12.60
66	F	Right	No	10.5	9.1^a	1.4	32.5	28.3	4.20
70	F	Left	No	13.9	10.5	3.4	40.5	30.1	10.40
76	M	Right	No	15	13.1	1.9	42.5	38.4	4.10
64	F	Right	No	12.6	9^a	3.6	36.3	26	10.30
62	F	Right	No	12.4	11.2	1.2	36.8	33.4	3.40
68	M	Left	No	13.4	13.4	0	37.9	31.1	6.80
74	F	Left	No	13.6	8.3^a	5.3	40.1	24.2	15.90
72	F	Right	No	12.7	11.7	1	36	33.5	2.50
56	F	Left	No	12.8	11.2	1.6	39.3	34.5	4.80
61	F	Right	No	12.9	10.3	2.6	39.7	31.3	8.40
76	M	Left	No	12.7	11.6	1.1	39.6	35.7	3.90
60	M	Right	No	14.7	11.2	3.5	43.8	32.7	11.10
66	F	Left	No	12.7	12.7	0	39.1	30	9.10
79	F	Left	No	11.7	8.7^a	3	36.6	28.1	8.50
77	M	Left	No	10.1	7.5^a	2.6	33.6	24.4	9.20
69	F	Left	No	13.2	12.3	0.9	41.7	38.3	3.40
69	F	Right	No	13.7	12	1.7	42	37.3	4.70
67	F	Left	No	12.5	9.8	2.7	39.7	30	9.70
71	F	Left	No	11.2	9.2^a	2	37	29.5	7.50
49	M	Right	No	14.2	12.3	1.9	41.8	36.2	5.60
68	F	Right	No	13.5	12.6	0.9	37.6	36.2	1.40
67	F	Left	No	11.1	9.5^a	1.6	34.6	29.8	4.80
65	F	Right	No	13.5	12.3	1.2	40	37	3.00
72	F	Left	No	13.8	11.8	2	40.3	34.2	6.10
79	M	Left	No	14.7	12.6	2.1	41.5	36.6	4.90
74	F	Right	No	14.3	11.5	2.8	41.9	33.5	8.40
Average standard deviation				12.97 ± 1.52	10.93 ± 1.63	2.04 ± 1.17	39.01 ± 3.95	32.19 ± 4.18	6.82 ± 3.37

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] * Corresponding author. E-mail: marcofelipebarros@hotmail.com (M.F. Barros).

Brasil

Brasil

Blood level changes in total knee arthroplasty with and without a tourniquet☆ ☆ Paper developed at Hospital Regional de Presidente Prudente, Serviço de Ortopedia e Traumatologia, Presidente Prudente, SP, Brazil.

ABSTRACT

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Blood level changes in total knee arthroplasty with and without a tourniquet^☆ ☆ Paper developed at Hospital Regional de Presidente Prudente, Serviço de Ortopedia e Traumatologia, Presidente Prudente, SP, Brazil.