[A meta-analysis for the efficacy and safety of tourniquet in total knee arthroplasty].

OBJECTIVE: To evaluate the efficacy and safety of tourniquet in total knee arthroplasty. METHOD: Studies on comparison between with and without tourniquet in total knee arthroplasty were identified from Medline, PubMed, EMASE, Cochrane Library, CBM, Highwire, CNKI, VIP, Articles Digital Periodicals.All the randomized controlled trials were included for meta-analysis with RevMan 4.2.2 software. RESULTS: Nineteen studies involving 15 in foreign languages, 4 in Chinese were identified. There were 1159 cases of knee replacement patients. The results of meta-analysis indicated that there were statistical difference between two groups on intraoperative blood loss (P = 0.000), the number of deep venous thrombosis (P = 0.020), thigh pain (P = 0.000), knee hematoma (P = 0.030), wound infection (P = 0.040), skin ecchymosis area (P = 0.000), and the increasing rate of knee circumference of 3 days after the operation (P = 0.000), while there were no statistical differences with respect to the total blood loss (P = 0.100), the number of blood transfusions (P = 0.150), operation time (P = 0.120), length of hospital stay (P = 0.350), the number of pulmonary embolism (P = 0.310), and skin blisters (P = 0.170). CONCLUSIONS: The tourniquet for total knee arthroplasty can reduce intraoperative blood loss, but can not reduce total blood loss and the number of blood transfusions transfusion, can not improve operative efficiency, can not shorten the hospitalization time and promote the knee joint functional recovery. Furthermore the tourniquet increases the probability of occurrence on deep vein thrombosis, wound infection, hematoma and ecchymosis knee, it also causes knee swelling and thigh pain. It suggests minimize to use tourniquet in total knee arthroplasty.

[Early clinical outcomes of fixed-bearing versus mobile-bearing total knee arthroplasty].

OBJECTIVE: To compare the early clinical outcomes of primary total knee arthroplasty by a fixed-bearing versus mobile-bearing prosthesis. METHODS: A total of 80 patients with osteoarthritis at our hospital from January 2008 to October 2008 were sequentially and randomly assigned into Group A (fixed-bearing prosthesis) (40 knees) and Group B (mobile-bearing prosthesis) (40 knees). And the data of the range of motion (ROM), Knee Society Score (KSS) and Western Ontario MacMaster (WOMAC) were collected at pre-operation and 6, 12 and 24 months post-operation respectively. RESULTS: The P values were as follows: KSS: 0.754, 0.802, 0.561, 0.764; HSS (Hospital for Special Surgery): 0.737, 0.361, 0.254, 0.330; WOMAC (Western Ontario and McMaster Universities) osteoarthritis index: 0.976, 0.557, 0.946, 0.818; ROM follow-up: 0.519, 0.646, 0.175, 0.276. No significant differences were found in clinical outcomes between two groups. CONCLUSION: The fixed-bearing and mobile-bearing prostheses show no difference in clinical outcomes.