Department of Orthopedic Surgery, Columbia University Irving Medical Center, 630 West 168(th) Street PH-11, New York, NY 10032, USA.
Department of Orthopedic Surgery, Columbia University Irving Medical Center, 630 West 168(th) Street PH-11, New York, NY 10032, USA.
Knee. 2024 Jan;46:19-26. doi: 10.1016/j.knee.2023.11.001. Epub 2023 Nov 21.
While tourniquet-free (T-) total knee arthroplasty (TKA) has gained popularity, tourniquet-use during minimally-invasive (MIS)-TKA has not been adequately studied. Traditional techniques employ knee hyper-flexion, compressing vasculature and reducing impact of bleeding, while MIS-TKA embraces the semi-extended knee position, which does not restrict the effects of bleeding on cementation and visualization. We compared the risk of aseptic loosening between patients undergoing T- MIS-TKA compared to T + MIS-TKA.
This single-surgeon cohort study included 329 consecutive MIS-TKA (226 T+,103 T-) patients with minimum 3-year follow-up. Aseptic loosening, radiolucent lines (RLL), health related quality of life scores, and complications were recorded. T-test and chi-square test were used to compare continuous and categorical variables, and logistic regression included BMI, age, ASA, patellar-resurfacing, and tourniquet-use.
There were no differences in baseline demographics. One (0.4 %) aseptic loosening occurred with T+, versus 7 (6.8 %) with T- (p = 0.002). No T + and 3 T- patients (2.9 %, p = 0.01) had revision for aseptic loosening. The incidence of RLLs was 16.8 % in T + and 30.1 % in T- (p = 0.008). Logistic regression revealed T + was significantly associated with decreased aseptic loosening and risk of RLL (odds ratio = 16.4, odds ratio = 2.8).
In this consecutive series, T- MIS-TKA was associated with increased rates of revision for aseptic loosening as compared to the T + MIS-TKA, even controlling for BMI, age, ASA level, and patellar resurfacing. Radiolucent lines were increased with T- MIS-TKA compared to T + MIS-TKA. Complications, all-cause revision, ROM, and HRQoL scores were similar between tourniquet-use and tourniquet-free cohorts.
虽然无止血带（T-）全膝关节置换术（TKA）已经流行起来，但微创（MIS）-TKA 中使用止血带的情况尚未得到充分研究。传统技术采用膝关节过度伸展，压迫血管，减少出血的影响，而 MIS-TKA 则采用半伸展膝关节的位置，这不会限制出血对骨水泥固定和可视化的影响。我们比较了接受 T- MIS-TKA 与 T+MIS-TKA 的患者发生无菌性松动的风险。
这是一项单外科医生队列研究，纳入了 329 例连续的 MIS-TKA（226 例 T+，103 例 T-）患者，随访时间至少为 3 年。记录无菌性松动、透亮线（RLL）、与健康相关的生活质量评分和并发症。使用 t 检验和卡方检验比较连续变量和分类变量，逻辑回归包括 BMI、年龄、ASA、髌骨表面置换和止血带使用。
基线人口统计学特征无差异。1 例（0.4%）T+患者发生无菌性松动，而 T-患者中有 7 例（6.8%）（p=0.002）。无 T+和 3 例 T-患者（2.9%，p=0.01）因无菌性松动行翻修。T+患者的 RLL 发生率为 16.8%，T-患者为 30.1%（p=0.008）。逻辑回归显示，T+与无菌性松动和 RLL 风险降低显著相关（比值比=16.4，比值比=2.8）。
在这项连续系列研究中，与 T+ MIS-TKA 相比，T- MIS-TKA 与无菌性松动的翻修率增加有关，即使控制 BMI、年龄、ASA 水平和髌骨表面置换。与 T+ MIS-TKA 相比，T- MIS-TKA 的 RLL 增加。止血带使用和无止血带组的并发症、全因翻修、ROM 和 HRQoL 评分相似。
