Zak Stephen G, Tang Alex, Pivec Robert, Meftah Morteza, Austin Matthew S, Schnaser Erik, Schwarzkopf Ran
Division of Adult Reconstruction, NYU Langone Orthopedic Hospital, Hospital for Joint Diseases, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA.
Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA.
Arch Orthop Trauma Surg. 2023 Jun;143(6):2877-2884. doi: 10.1007/s00402-022-04470-w. Epub 2022 May 13.
Aseptic loosening is a common cause of implant failure following total knee arthroplasty (TKA). Cement penetration depth is a known factor that determines an implant's "strength" and plays an important role in preventing aseptic loosening. Tourniquet use is thought to facilitate cement penetration, but its use has mixed reviews. The aim of this study was to compare cement penetration depth between tourniquet and tourniquet-less TKA patients.
A multicenter retrospective review was conducted. Patients were randomized preoperatively to undergo TKA with or without the use of an intraoperative tourniquet. The variables collected were cement penetration measurements in millimeters (mm) within a 1-month post-operative period, length of stay (LOS), and baseline demographics. Measurements were taken by two independent raters and made in accordance to the zones described by the Knee Society Radiographic Evaluation System and methodology used in previous studies.
A total of 357 TKA patients were studied. No demographic differences were found between tourniquet (n = 189) and tourniquet-less (n = 168) cohorts. However, the tourniquet cohort had statistically, but not clinically, greater average cement penetration depth [2.4 ± 0.6 mm (range 1.2-4.1 mm) vs. 2.2 ± 0.5 mm (range 1.0-4.3 mm, p = 0.01)]. Moreover, the tourniquet cohort had a significantly greater proportion of patients with an average penetration depth within the accepted zone of 2 mm or greater (78.9% vs. 67.3%, p = 0.02).
Tourniquet use does not affect average penetration depth but increases the likelihood of achieving optimal cement penetration depth. Further study is warranted to determine whether this increased likelihood of optimal cement penetration depth yields lower revision rates.
无菌性松动是全膝关节置换术（TKA）后植入物失败的常见原因。骨水泥渗透深度是决定植入物“强度”的一个已知因素，在预防无菌性松动方面起着重要作用。使用止血带被认为有助于骨水泥渗透，但其使用评价不一。本研究的目的是比较使用止血带和不使用止血带的TKA患者的骨水泥渗透深度。
进行了一项多中心回顾性研究。患者术前随机分为接受使用或不使用术中止血带的TKA手术。收集的变量包括术后1个月内以毫米（mm）为单位的骨水泥渗透测量值、住院时间（LOS）和基线人口统计学数据。测量由两名独立的评估者进行，并按照膝关节协会放射学评估系统描述的区域以及先前研究中使用的方法进行。
共研究了357例TKA患者。使用止血带组（n = 189）和不使用止血带组（n = 168）之间未发现人口统计学差异。然而，使用止血带组的平均骨水泥渗透深度在统计学上更高，但在临床上无显著差异[2.4±0.6 mm（范围1.2 - 4.1 mm）对2.2±0.5 mm（范围1.0 - 4.3 mm，p = 0.01）]。此外，使用止血带组平均渗透深度在公认的2 mm或更大区域内的患者比例显著更高（78.9%对67.3%，p = 0.02）。
使用止血带不影响平均渗透深度，但增加了实现最佳骨水泥渗透深度的可能性。有必要进一步研究以确定这种最佳骨水泥渗透深度增加的可能性是否会降低翻修率。
