The Tourniquet Pressure 200 mmHg for Total Knee Arthroplasty: is it possible? / 대한정형외과연구학회지

PURPOSE: To evaluate the possibility of lowering tourniquet pressure to 200 mmHg during total knee arthroplasty (TKA) by pressing the femoral artery. Lowering the toniquette pressure can attribute to minimize the soft tissue damage and pain after the operation. MATERIALS AND METHODS: We analyzed patients who had TKA from Sep 16th, 2010 to Mar 3rd, 2011. Among them, 35 patients (test I) had operations on both knees, and 50 patients (test II) underwent operation on one knee. We excluded the patients who had a previous operation, infection, or bleeding tendency. We put a cotton roll at the antero-medial side of the thigh just under the tourniquet in order to apply more pressure on the femoral artery that is scanned by ultrasonography. We scored 0 on non-bleeding, 1 on bleeding that did not affect the operation, and 2 on bleeding which disturbed the operation. RESULTS: In test I, the group which applied 200 mmHg with local pressure, 24 patients (68.6%) scored 0, 9 patients (25.7%) scored 1, and two patients (5.7%) scored 2. In the other group used pressure 250 mmHg, however, 31 patients (88.6%) scored 0, 4 patients (11.4%) scored 1, and no one scored 2 (p=0.039). Totally, in the 200 mmHg group with local pressure, 33 patients had no problem in surgery, and only for 2 patients (5.7%), we had to increase pressure. For the patients with 250 mmHg, however, we had to increase pressure on nobody (0%). In test II, in the group which had operation on one knee with 200 mmHg with local pressure, 14 patients scored 0, 8 patients scored 1, and one patient scored 2. Also in the 250 mmHg group, 24 patients scored 0, 2 patients scored 1, and one patient scored 2. (p=1.000). Overall results demonstrate no differences in bleeding that disturb operations statistically. CONCLUSION: Even with a little more bleeding compared to the 250 mmHg group, 94.8% of patients can have operation with no bleeding problems by using a cotton roll and the pressure 200 mmHg. For successful operations, there is no difference between groups using 250 mmHg and 200 mmHg with local pressure on femoral artery.

Relationship between the Tourniquet Pressure and the Amount of Subcutaneous Bleeding after Total Knee Replacement

PURPOSE: We wanted to evaluate the post-operative amount of subcutaneous bleeding according to the tourniquet pressure during total knee replacement. MATERIALS AND METHODS: We analyzed 136 patients who had undergone total knee replacement at our hospital from March 4th, 2010 to September 16th, 2010. A tourniquet pressure of 250 mm Hg was applied to 69 patients (group I) and a tourniquet pressure of 320 mm Hg was applied to the other 67 patients (group II). Subcutaneous bleeding was evaluated on the 3rd and 6th days after the operations. All of the total knee replacements were performed by a single surgeon. RESULTS: Among the group I patients, subcutaneous bleeding was seen in just 2 patients, yet among the group II patients, there were 32 patients with subcutaneous bleeding on the 3rd day and 33 patients with subcutaneous bleeding on the 6th day. According to the multiple regression analysis, there were no significant differences in ages, the tourniquet time and the orders between the two groups. Group 1 had significantly less subcutaneous bleeding than did group II on the 3rd and 6th days after the operations (p=0.001). CONCLUSION: There was a significant difference of the amount of subcutaneous bleeding amount according to the tourniquet pressure. We were able to decrease the post-operative amount of subcutaneous bleeding after total knee replacement by lowering the tourniquet pressure to 250 mm Hg.

The Measurement of Tissue Pressure Beneath a Tourniquet in the Thigh, and Normal Blood Flow Recovery Time After a Tourniquet Release / 대한정형외과학회잡지

A bloodless field is essential for orthopedic surgery. Although a touriquet is necessary, it is dangerous because of soft tissue damage. We studied the soft tissue pressure beneath a tourniquet in the thigh to identify the accurate pressure for the bloodless field, and recovery time of normal blood flow after tourniquet release as related to the time of tourniquet use. From June, 1986, to Marth 1987, the soft tissue pressure of 21 lower extremities beneath the tourniquets was measured by the slit catheter method, and the noraml blood flow recovery time of 21 lower extremities after the tourniquet release was measured by a photoplethysmograph. The results were follows : Tourniquet pressure of 400 mmHg was enough for a bloodless field. So we can prevent the tissue damage due to excessive tourniquet pressure. The soft tissue pressure beneath a tourniquet was not affected by the age, weight, height or thigh circumference of the subjects. The recovery time to normal blood flow after tourniquet relase was prolonged with the time of tourniquet use. The recovery time to normal blood flow after tourniquet relase was not affected by age, weight, height, or thigh circumference of the subjects.