Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-08-2016 | Knee

Comparison of quadriceps muscle volume after unilateral total knee arthroplasty with and without tourniquet use

Authors: Olcay Guler, Mahir Mahirogullari, Mehmet Isyar, Ahmet Piskin, Sercan Yalcin, Serhat Mutlu, Bünyamin Sahin

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2016

Abstract

Purpose

Determination of the effect of tourniquet use in total knee arthroplasty (TKA) on thigh and quadriceps muscle volume using magnetic resonance imaging (MRI).

Methods

A total of 148 knees of 74 patients (mean age 66.5 ± 4.8 years; female/male, 62/12) with bilateral primary varus gonarthrosis underwent unilateral TKA with a tourniquet (Group A, n = 35) or without a tourniquet (Group B, n = 39). The total thigh volume and connective, bone, and muscle tissue volumes were stereologically measured on preoperative and postoperative MRI. The Knee Society Score (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were calculated to evaluate functional outcomes.

Results

After TKA, the knees of patients in Group A exhibited a significant decrease in all tissue measurements, except bone tissue volume; however, the knees of patients in Group B exhibited no significant difference in tissue measurements. Although no difference was found between the operated and contralateral non-operated thighs (4076.9 and 4073.4 cm³, respectively) in Group B postoperatively at 1 month (p > 0.05), the operated thighs had lost 20 % of its volume in Group A postoperatively at 1 month (p < 0.001). A significant difference was found in all tissue measurements, except the connective and bone tissue volumes of the thigh between the operated and contralateral non-operated knees in Group A. No significant difference was identified between the operated and contralateral non-operated knees in Group B. The total WOMAC score was significantly higher, and the total KSS was significantly lower in Group A than in Group B during the postoperative follow-up period of 1–6 months (p < 0.001 for all) but not 12 months (n.s.).

Conclusion

Tourniquet use in TKA decreases the thigh and quadriceps muscle volumes and postoperatively delays the recovery of knee function. Therefore, caution should be exercised for tourniquet use during TKA in daily clinical practice and using alternative methods for tourniquet application in preventing intraoperative blood loss.

Level of evidence

III.

Alcelik I, Pollock RD, Sukeik M, Bettany-Saltikov J, Armstrong PM, Fismer P (2012) A comparison of outcomes with and without a tourniquet in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Arthroplasty 27:331–340CrossRefPubMed

Bellamy N (1989) Pain assessment in osteoarthritis: experience with the WOMAC osteoarthritis index. Semin Arthritis Rheum 18:14–17CrossRefPubMed

Bidolegui F, Arce G, Lugones A, Pereira S, Vindver G (2014) Tranexamic acid reduces blood loss and transfusion in patients undergoing total knee arthroplasty without tourniquet: a prospective randomized controlled trial. Open Orthop J 8:250–254CrossRefPubMedPubMedCentral

Ejaz A, Laursen AC, Kappel A, Laursen MB, Jakobsen T, Rasmussen S, Nielsen PT (2014) Faster recovery without the use of a tourniquet in total knee arthroplasty. Acta Orthop 85:422–426CrossRefPubMedPubMedCentral

Fan Y, Jin J, Sun Z, Li W, Lin J, Weng X, Qiu G (2014) The limited use of a tourniquet during total knee arthroplasty: a randomized controlled trial. Knee 21:1263–1268CrossRefPubMed

Gielen M (1991) Cardiac arrest after tourniquet release. Can J Anaesth 38:541CrossRefPubMed

Greene KA, Schurman JR 2nd (2008) Quadriceps muscle function in primary total knee arthroplasty. J Arthroplasty 23(7 Suppl):15–19CrossRefPubMed

Hocker AD, Boileau RM, Lantz BA, Jewett BA, Gilbert JS, Dreyer HC (2013) Endoplasmic reticulum stress activation during total knee arthroplasty. Physiol Rep 1:e00052CrossRefPubMedPubMedCentral

Jiang FZ, Zhong HM, Hong YC, Zhao GF (2015) Use of a tourniquet in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Orthop Sci 20:110–123CrossRefPubMed

10.

Jorgensen HR (1987) Myoglobin release after tourniquet ischemia. Acta Orthop Scand 58:554–556CrossRefPubMed

11.

Kelley TC, Tucker KK, Adams MJ, Dalury DF (2014) Use of tranexamic acid results in decreased blood loss and decreased transfusions in patients undergoing staged bilateral total knee arthroplasty. Transfusion 54:26–30CrossRefPubMed

12.

Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502CrossRefPubMedPubMedCentral

13.

Li B, Wen Y, Wu H, Qian Q, Lin X, Zhao H (2009) The effect of tourniquet use on hidden blood loss in total knee arthroplasty. Int Orthop 33:1263–1268CrossRefPubMed

14.

Liu D, Graham D, Gillies K, Gillies RM (2014) Effects of tourniquet use on quadriceps function and pain in total knee arthroplasty. Knee Surg Relat Res 26:207–213CrossRefPubMedPubMedCentral

15.

Lohmann-Jensen R, Holsgaard-Larsen A, Emmeluth C, Overgaard S, Jensen C (2014) The efficacy of tourniquet assisted total knee arthroplasty on patient-reported and performance-based physical function: a randomized controlled trial protocol. BMC Musculoskelet Disord 15:110CrossRefPubMedPubMedCentral

16.

Maden-Wilkinson TM, Degens H, Jones DA, McPhee JS (2013) Comparison of MRI and DXA to measure muscle size and age-related atrophy in thigh muscles. J Musculoskelet Neuronal Interact 13:320–328PubMed

17.

McGrath BJ, Hsia J, Epstein B (1991) Massive pulmonary embolism following tourniquet deflation. Anesthesiology 74:618–620CrossRefPubMed

18.

Olivecrona C, Blomfeldt R, Ponzer S, Stanford BR, Nilsson BY (2013) Tourniquet cuff pressure and nerve injury in knee arthroplasty in a bloodless field: a neurophysiological study. Acta Orthop 84:159–164CrossRefPubMedPubMedCentral

19.

Olivecrona C, Ponzer S, Hamberg P, Blomfeldt R (2012) Lower tourniquet cuff pressure reduces postoperative wound complications after total knee arthroplasty: a randomized controlled study of 164 patients. J Bone Joint Surg Am 94:2216–2221CrossRefPubMed

20.

Pfitzner T, von Roth P, Voerkelius N, Mayr H, Perka C, Hube R (2014) Influence of the tourniquet on tibial cement mantle thickness in primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3341-6

21.

Saleh KJ, Lee LW, Gandhi R, Ingersoll CD, Mahomed NN, Sheibani-Rad S, Novicoff WM, Mihalko WM (2010) Quadriceps strength in relation to total knee arthroplasty outcomes. Instr Course Lect 59:119–130PubMed

22.

Saunders KC, Louis DL, Weingarden SI, Waylonis GW (1979) Effect of tourniquet time on postoperative quadriceps function. Clin Orthop Relat Res 143:194–199PubMed

23.

Tai TW, Lin CJ, Jou IM, Chang CW, Lai KA, Yang CY (2011) Tourniquet use in total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 19:1121–1130CrossRefPubMed

24.

Tamvakopoulos GS, Toms AP, Glasgow M (2005) Subcutaneous thigh fat necrosis as a result of tourniquet control during total knee arthroplasty. Ann R Coll Surg Engl 87:W11–W13CrossRefPubMedPubMedCentral

25.

Tarwala R, Dorr LD, Gilbert PK, Wan Z, Long WT (2014) Tourniquet use during cementation only during total knee arthroplasty: a randomized trial. Clin Orthop Relat Res 472:169–174CrossRefPubMed

26.

Thienpont E (2013) Faster quadriceps recovery with the far medial subvastus approach in minimally invasive total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21:2370–2374CrossRefPubMed

27.

Unver B, Karatosun V, Tuncali B (2013) Effects of tourniquet pressure on rehabilitation outcomes in patients undergoing total knee arthroplasty. Orthop Nurs 32:217–222CrossRefPubMed

28.

Wakankar HM, Nicholl JE, Koka R, D’Arcy JC (1999) The tourniquet in total knee arthroplasty. A prospective, randomised study. J Bone Joint Surg (Br) 81:30–33CrossRef

29.

Wauke K, Nagashima M, Kato N, Ogawa R, Yoshino S (2002) Comparative study between thromboembolism and total knee arthroplasty with or without tourniquet in rheumatoid arthritis patients. Arch Orthop Trauma Surg 122:442–446PubMed

30.

Westman B, Weidenhielm L, Rooyackers O, Fredriksson K, Wernerman J, Hammarqvist F (2007) Knee replacement surgery as a human clinical model of the effects of ischaemia/reperfusion upon skeletal muscle. Clin Sci (Lond) 113:313–318CrossRef

31.

Yi S, Tan J, Chen C, Chen H, Huang W (2014) The use of pneumatic tourniquet in total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg 134:1469–1476CrossRefPubMed

32.

Zan PF, Yang Y, Fu D, Yu X, Li GD (2015) Releasing of tourniquet before wound closure or not in total knee arthroplasty: a meta-analysis of randomized controlled trials. J Arthroplasty 30:31–37CrossRefPubMed

33.

Zhang W, Li N, Chen S, Tan Y, Al-Aidaros M, Chen L (2014) The effects of a tourniquet used in total knee arthroplasty: a meta-analysis. J Orthop Surg Res 9:13CrossRefPubMedPubMedCentral

34.

Zhang W, Liu A, Hu D, Tan Y, Al-Aidaros M, Pan Z (2014) Effects of the timing of tourniquet release in cemented total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res 9:125CrossRefPubMedPubMedCentral

Title: Comparison of quadriceps muscle volume after unilateral total knee arthroplasty with and without tourniquet use
Authors: Olcay Guler
Mahir Mahirogullari
Mehmet Isyar
Ahmet Piskin
Sercan Yalcin
Serhat Mutlu
Bünyamin Sahin
Publication date: 01-08-2016
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-015-3872-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison of quadriceps muscle volume after unilateral total knee arthroplasty with and without tourniquet use

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Please log in to get access to this content

Other articles of this Issue 8/2016

Total knee arthroplasty in patients with Charcot joints

Quadriceps strength asymmetry predicts loading asymmetry during sit-to-stand task in patients with unilateral total knee arthroplasty

Alignment in total knee arthroplasty

No differences in functional results and quality of life after single-radius or multiradius TKA

The reversed gap technique produces anatomical alignment with less midflexion instability in total knee arthroplasty: a prospective randomized trial

Comment on ‘extension gap needs more than 1-mm laxity after implantation to avoid post-operative flexion contracture in total knee arthroplasty’