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Tibial cement mantle thickness is not affected by tourniquetless total knee arthroplasty when performed with tranexamic acid

  • Carl L. HerndonEmail author
  • Matthew J. Grosso
  • Nana O. Sarpong
  • Roshan P. Shah
  • Jeffrey A. Geller
  • H. John Cooper
KNEE
  • 25 Downloads

Abstract

Purpose

Evidence exists that tourniquet use leads to increased cement penetration in total knee arthroplasty (TKA) due to decreased blood and fat in the bone during cementation. The use of tranexamic acid (TXA) has led to decreased blood loss and transfusion rates. The purpose of this study was to determine if the use of a tourniquet while utilising modern TXA protocols affects the tibial cement mantle penetration.

Methods

140 patients who underwent primary TKA with and without a tourniquet (70 in each group) were retrospectively reviewed. All patients received a standard TXA protocol. The primary outcome measure was cumulative depth of cement mantle penetration of the tibial plateau on post-operative radiographs. Secondary outcome measures included post-operative change in haemoglobin and hematocrit levels, blood loss, and transfusion rates.

Results

There was no significant difference in age, sex, or pre-operative haemoglobin or hematocrit levels between groups. Tourniquet use resulted in significantly lower blood loss (100.0 mL versus 154.7 mL, p < 0.001), and significantly reduced drop in haemoglobin (1.8 g/dL vs 2.5 g/dL, p < 0.001) and hematocrit (5.7% vs 7.4%, p = 0.04) levels. However, depth of tibial cement mantle penetration did not differ between the tourniquet group (15.3 mm) and non-tourniquet group (15.0 mm, p value n.s.). No patient in either group required a blood transfusion.

Conclusions

Tourniquet use in primary TKA results in decreased blood loss and less change in pre-operative vs post-operative haemoglobin and hematocrit levels. However, with the use of TXA, not using a tourniquet resulted in similar cement mantle penetration around the tibial component as with a tourniquet.

Keywords

Total knee arthroplasty Total knee replacement Tranexamic acid Tourniquet Cementation Cement penetration 

Abbreviations

TKA

Total knee arthroplasty

TXA

Tranexamic acid

IRB

Institutional review board

Hg

Haemoglobin

Hct

Hematocrit

T

Tourniquet

NT

No tourniquet

CI

Confidence interval

Notes

Author contributions

CLH devised the study, did the data collection, analysis, and wrote the manuscript. MJG devised the study, did the data collection, analysis, and wrote the manuscript. NOS did the data collection, analysis and wrote the manuscript. RPS edited the manuscript and provided guidance with the study. JAG edited the manuscript and provided guidance with the study. HJC provided patient data, devised the study, and edited the manuscript. All the authors have read and approve of the final manuscript.

Compliance with ethical standards

Conflict of interest

All authors report no relevant conflicts of interest in this study.

Funding

This study received no outside or additional funding.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Orthopedic Surgery, Center for Hip and Knee ReplacementColumbia University Irving Medical CenterNew YorkUSA

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