Influence of Tourniquet Use and Surgery Duration on the Incidence of Deep Vein Thrombosis in Total Knee Arthroplasty

March 19, 2012 updated by: University of Sao Paulo General Hospital
This is an observational study to analyze the influence of surgery duration and tourniquet time in the incidence of deep venous thrombosis (DVT) in patients that had undergone total knee arthroplasty (TKA).

Study Overview

Status

Completed

Conditions

Detailed Description

Influence of Tourniquet Use and Surgery Duration on the Incidence of Deep Vein Thrombosis in Total Knee Arthroplasty

Tourniquet, Surgery Duration and DVT in TKA.

Abstract:

Objective: The occurrence of deep vein thrombosis (DVT) was evaluated in 78 patients submitted to total knee arthroplasty (TKA), followed by ascending venography (AV), between the seventh and twelfth days postoperative.

Methods: Patients received prophylaxis with oral anticoagulation for 12 days, maintaining INR at around 2.5.

Results: Results showed 45 cases (57.7%) of negative bilateral AV and 33 (42.3%) cases of positivity for DVT. Thirteen cases were of the proximal type DVT, making up 16.7% of the total. We compared the groups with and without DVT, and another which considered only cases with proximal DVT.

Conclusion: The statistical analysis didn't reveal significance in relation to tourniquet time, despite the higher likelihood of proximal DVT after 90 minutes (p=0.08) and surgery duration of more than 120 minutes increases its risk.

Keywords: Deep vein thrombosis. Prophylaxis. Thromboembolism. Tourniquet. Knee prosthesis.

Introduction Total knee arthroplasties (TKAs), together with total hip arthroplasties, are frequently the object of study regarding deep vein thrombosis (DVT) (1); however, DVT also commonly occurs in other knee procedures (2). Despite the importance of this problem and the interest in it, most researchers studying DVT generally focus on prophylaxis for prevention; surprisingly, there have been few studies of the isolated risk factors for DVT associated with TKA. Although there is some controversy about the role of TKA alone as a risk factor for DVT (3-7), some researchers believe that bone manipulation, reaming of the medullary canal, and the duration of the different procedures are relevant risk factors for DVT (8,9). Another important and controversial factor related to TKA is the use of surgical tourniquets. Although all these factors are mentioned in the literature, surgery duration as an isolated risk factor for DVT in TKA has received little attention.

We used ascending venography (AV) to evaluate the association between the use of tourniquets and total procedure duration and the occurrence of DVT during TKA.

Patients and Methods Seventy-eight consecutive patients from our institution underwent cemented TKA for degenerative knee disorders and then underwent AV, for which they gave informed consent, at a point between 7 and 12 days after surgery, after having been discharged from the hospital. Of the 78, 78.2% were women and 21.8% were men, with an average age of 65.1 years (range, 31-88 years; SD, 11.5 years). Osteoarthrosis was the diagnosis in 74.4%, rheumatoid arthritis in 21.8%, and other disorders in 3.8%.

All patients received prophylaxis for DVT with oral anticoagulants for 12 days, with an international normalized ratio being maintained at about 2.5 (range, 2.0-3.0) in all cases. Perioperatively, we recorded total pneumatic tourniquet time and total surgery duration, in minutes. In all cases, the use of a tourniquet was interrupted by hemostasis, after cementation of the implant and before wound closure. Five categories were established for total tourniquet time: <60, 61 to 90, 91 to 120, and >120 minutes. The total procedure duration was defined in the same way; we recorded the times of the initial incision and the last suture stitch made to close the incision. Three categories were defined for procedure duration: <120, 121 to 150, and >150 minutes. Only 2 patients (3.1%) were given a general anesthetic; all the others were given a spinal block.

The study end point was defined as the execution of bilateral AV at a point between 7 and 12 days after surgery, after hospital discharge. The AV was carried out by a specialist in vascular radiology. The technique applied was basically that described by Rabinov and Paulin (10). The presence of clinically manifested DVT and/or pulmonary embolism was also taken in to consideration. The clinical manifestations of DVT were greater edema of the lower limb than would be expected for the procedure, associated with intense pain on palpation of the calf and pain on passive dorsiflexion of the foot.

AV findings were considered positive for DVT in the presence of blood clots in the vein lumens (Figure 1). They were characterized as occurring on the operated side, contralateral or bilateral, and were diagnosed as proximal DVT (more severe) or distal DVT (less severe), depending on the contents of the radiologist's report.

Study Type

Observational

Enrollment (Actual)

78

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Brazil
      • São Paulo, Brazil, 05403-010
        • Orthopedics Department - University of Sao Paulo General Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

30 years to 90 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

Seventy-eight consecutive patients from our institution underwent cemented TKA for degenerative knee disorders and then underwent AV, for which they gave informed consent, at a point between 7 and 12 days after surgery, after having been discharged from the hospital.

Description

Inclusion Criteria:

  • patients that underwent cemented total knee arthroplasty

Exclusion Criteria:

  • post-operative infection
  • inadequate follow-up

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
ATK patients
Patients from our institution that underwent cemented TKA for degenerative knee disorders.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Deep vein thrombosis
Time Frame: 7 days
Deep vein thrombosis confirmed by ascending venography performed 7 days after total knee arthroplasty.
7 days

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Sao Paulo General Hospital

Investigators

  • Study Director: Arnaldo J Hernandez, Prof. Dr., Orthopedics and Traumatology Department - University of Sao Paulo General Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

February 1, 2008

Primary Completion (Actual)

June 1, 2011

Study Completion (Actual)

September 1, 2011

Study Registration Dates

First Submitted

March 13, 2012

First Submitted That Met QC Criteria

March 19, 2012

First Posted (Estimate)

March 21, 2012

Study Record Updates

Last Update Posted (Estimate)

March 21, 2012

Last Update Submitted That Met QC Criteria

March 19, 2012

Last Verified

March 1, 2012

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 222

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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