Effectiveness of Hemostasis Methods in Total Knee Arthroplasty

The use of tourniquets and bipolar sealers are effective methods of hemostasis during total knee arthroplasty (TKA). However, their effect on perioperative patient outcomes is unknown.

Stephen G. Zak et al conducted a study to compare the efficacy of tourniquet-less, tourniquet-less with use of a bipolar sealer, and tourniquet use on postoperative pain and surgical outcomes following TKA. The article has been published in the Indian Journal of Orthopedics.

The authors found that both bipolar sealer and tourniquet use in TKA are associated with similar postoperative pain levels and length of stay (LOS) in comparison to tourniquet-less only TKA. However, bipolar sealer and tourniquet use may lead to better longer-term improvement such as greater patient-reported outcome (PRO) score improvement and fewer readmissions.

A retrospective study of prospectively collected data of 120 primary TKA cases was conducted at an urban academic hospital. Primary outcomes were visual analog scale (VAS) scores and opioid consumption (in morphine milligram equivalents). Demographics, length of stay (LOS), perioperative complications, and change in Knee Injury and Osteoarthritis Outcome Score (ΔKOOS) were also collected. Patients were divided into cohorts based on the use of tourniquet-less with bipolar sealer (TRLB) (n=40), tourniquet (TR) (n=40), or tourniquet-less (TRL) (n=40).

Observations of the Study

• There were no differences in demographic data between each cohort.
• TRLB, TR, and TRL had similar LOS (2.68±1.63 vs 2.29±1.27 vs 2.36±1.42 days; p=0.472) and VAS pain score on postoperative day 1 (4.68 vs 3.74 vs 3.63; p=0.209).
• There were no differences in opioid consumption at 2 weeks (p=0.903), 1 month (p=0.973), 3 months (p=0.983), or 5 months (p=0.983) post-operatively.
• TRLB and TR had comparable improvement in ΔKOOS from baseline to 12 weeks post-operatively (Δ16.58±8.47 vs Δ23.92±14.60; p=0.254). Compared to the ΔKOOS of TRL (Δ5.19±2.59), TRLB and TR had clinically and statistically greater ΔKOOS improvements (p=0.009; p=0.001).
• The TRL cohort also had a higher readmission rate than TRLB and TR (15% vs 0% vs 5%, p=0.025).

The authors commented, "In addition to maintaining hemostasis, blood loss reduction devices seem to provide intraoperative and perioperative benefits that may greatly assist surgeons in improving outcomes and recovery."

Further Reading

Bipolar Sealers and Tourniquet Use Have Similar Outcomes in Total Knee Arthroplasty
Stephen G. Zak, Nishanth Muthusamy et al
Indian Journal of Orthopaedics (2022) 56:1745–1750
https://doi.org/10.1007/s43465-022-00670-z