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| Name | Class |
|---|---|
| Karolinska Institutet | OTHER |
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Different strategies of tourniquet application during elective primary total knee arthroplasty are thought to be associated with different outcomes. In that context, the study investigates different tactics in the search of optimal application of the tourniquet and the related fluid management during 24 perioperative hours.
The optimal application of tourniquet should reduce perioperative blood loss, create bloodless operative field, improve cementing technique and shorten surgery time. Meanwhile, inadequate application may increase the risk of deep vein thrombosis and pulmonary thromboembolism. Previous attempts to compare the tourniquet strategies in respect to the perioperative blood loss did not show significant difference. The investigators use the volume loading test aiming to optimize the fluid status and obtain the hemoglobin concentration in the conditions of standardized plasma dilution. The test is deployed just before the surgery and after postoperative 24 hrs in ICU. Functional outcomes and possible length of hospital stay is also evaluated.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| I tourniquet tactic | Other | Use volume loading test twice (before surgery and 24hrs postoperatively). Total knee arthroplasty performed under tourniquet. Lower limb tourniquet inflation- before incision, deflation- after bone cement set. |
|
| II tourniquet tactic | Other | Use volume loading test twice (before surgery and 24hrs postoperatively). Total knee arthroplasty performed under tourniquet. Lower limb tourniquet inflation- before cement application, deflation- after bone cement set. |
|
| III tourniquet tactic | Other | Use volume loading test twice (before surgery and 24hrs postoperatively). Total knee arthroplasty performed under tourniquet. Lower limb tourniquet inflation- before incision, deflation- after wound closure |
|
| IV control group | Other | Do not use volume loading test. Total knee arthroplasty performed under tourniquet. Lower limb tourniquet inflation- before cement application, deflation- after bone cement set. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Total knee arthroplasty performed under tourniquet | Procedure | Comparison of the different tourniquet tactics. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Perioperative blood loss. | The volume loading test is deployed for the comparison of perioperative hemoglobin in the standardized plasma dilution. | Before (baseline) the surgery and 24 hrs postoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| Wound healing | Within 6 days postoperatively | |
| Hemodilution | Within 6 days postoperatively | |
| Cardiac stroke volume |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Narunas Porvaneckas, PhD | Medical Faculty of Vilnius University, Clinic of Rheumatology, Traumatology and reconstructive surgery | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Republic Vilnius University Hospital | Vilnius | LT-04130 | Lithuania |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 23052115 | Result | Kvederas G, Porvaneckas N, Andrijauskas A, Svensen CH, Ivaskevicius J, Mazunaitis J, Marmaite U, Andrijauskas P. A randomized double-blind clinical trial of tourniquet application strategies for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2013 Dec;21(12):2790-9. doi: 10.1007/s00167-012-2221-1. Epub 2012 Sep 28. |
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| Type | Date | Date Unknown |
|---|---|---|
| Release | Dec 28, 2014 | |
| Reset | Jan 8, 2015 |
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| Release Date | Unrelease Date | Unrelease Date Unknown | Reset Date | MCP Release Number |
|---|---|---|---|---|
| Dec 28, 2014 | Jan 8, 2015 |
| ID | Term |
|---|---|
| D020370 | Osteoarthritis, Knee |
| D006470 | Hemorrhage |
| ID | Term |
|---|---|
| D010003 | Osteoarthritis |
| D001168 | Arthritis |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
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|
| Within 6 days postoperatively |
| Body temperature | Within 6 days postoperatively |
| Pain (Visual Analog Scale) | Within 6 days postoperatively |
| Number of opiate injections | Within 6 days postoperatively |
| Straight-leg raising test | Within 6 days postoperatively |
| Timed up and go test | Within 6 days postoperatively |
| Knee flexion, extension, extension lag | Within 6 days postoperatively |
| Knee swelling | Within 6 days postoperatively |
| Complications | Within 6 days postoperatively |
| D012216 |
| Rheumatic Diseases |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |