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Reinflation After Early Tourniquet Release in Total Knee Arthroplasty

18 mei 2014 bijgewerkt door: Tae Kyun Kim, Seoul National University Hospital

The Effects of Tourniquet Reinflation After Early Tourniquet Release in Total Knee Arthroplasty

This study is aimed to determine the efficacy and the safety of the tourniquet reinflation after early tourniquet release in total knee arthroplasty, compared to the method of early deflation without reinflation. The investigators hypothesized that the reinflation after early release of the tourniquet would be effective in terms of improved visualization of the surgical field and decreased operation time and blood loss, whereas it would increase tourniquet-related complication due to longer tourniquet-use time.

Studie Overzicht

Toestand

Onbekend

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

Total knee arthroplasty(TKA) is mostly performed with tourniquet applied, because it allows decreased intraoperative blood loss, better visualization of surgical field and better cement fixation of the implants, compared to the TKA without using tourniquet. However, there remains a controversy about the timing of tourniquet release, so the tourniquet may be unreleased throughout the whole operation time or released early just after cement fixation of the implants, atc. Early tourniquet release is generally aimed to control hidden arterial bleeding which would not be revealed if the tourniquet was unreleased. This method was reported to reduce arterial bleeding and its related complications, but it was also known that increase intraoperative bleeding, incidence of transfusion, and operation time. On the other hand, late tourniquet release, which the tourniquet is unreleased until the wound is closed, is reported to increase tourniquet-use time and related complications owing to longer tourniquet time, although it gives shorter operation time. The investigators have been used a way of reinflation of tourniquet after early release, once the arterial bleeding was controlled sufficiently, to balance the advantages and disadvantages of the early tourniquet release. The investigators were able to control arterial bleeding during the time the tourniquet was released, and the remained procedures were performed conveniently with good visualization of the surgical field after the tourniquet was reinflated again. However, there was no previous studies about the efficacy and the safety of the way of reinflation after early release of the tourniquet in the literature. Therefore, the investigators ask in this study whether the reinflation after early tourniquet release has advantages over the method of early tourniquet release without reinflation, in terms of efficacy and safety.

Studietype

Ingrijpend

Inschrijving (Verwacht)

174

Fase

  • Fase 4

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studie Locaties

  • Korea, republiek van
    • Gyeonggi-do
      • Seongnam-Si, Gyeonggi-do, Korea, republiek van, 463-707
        • Werving
        • Joint Reconstruction Center, Seoul National University Bundang Hospital
        • Contact:
          • Tae Kyun Kim, MD, PhD
          • Telefoonnummer: 82-31-787-7196
          • E-mail: osktk@snubh.org

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

40 jaar tot 90 jaar (Volwassen, Oudere volwassene)

Accepteert gezonde vrijwilligers

Nee

Geslachten die in aanmerking komen voor studie

Allemaal

Beschrijving

Inclusion Criteria:

  • Diagnosis of primary osteoarthritis of the knee
  • Scheduled for elective total knee arthroplasty
  • Written signed consent

Exclusion Criteria:

  • Revision TKA
  • Diagnosis other than primary osteoarthritis
  • Intra-articular indwelling drainage
  • Refusing participate

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

  • Primair doel: Behandeling
  • Toewijzing: Gerandomiseerd
  • Interventioneel model: Parallelle opdracht
  • Masker: Dubbele

Wapens en interventies

Deelnemersgroep / Arm
Interventie / Behandeling
Experimenteel: Reinflation after early deflation
The tourniquet is released after cement implant fixation, and then reinflated, once arterial bleeding was controlled (Reinflation after early tourniquet deflation).
Procedure: Reinflation after early tourniquet deflation
The tourniquet is released after cement implant fixation, and then reinflated, once arterial bleeding was controlled
Andere namen:
  • Reinflation after early tourniquet release
Geen tussenkomst: No reinflation after early deflation
The tourniquet is released after cement implant fixation, and remained deflated without reinflation, even after hemostasis.

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Operation time
Tijdsspanne: from skin incision to wound closure
Total time between initial skin incision and wound closure
from skin incision to wound closure

Secundaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Tourniquet time
Tijdsspanne: total sum of time between inflation and deflation of tourniquet
Total time of tourniquet-use during the operation which defined from skin incision to the wound closure
total sum of time between inflation and deflation of tourniquet
Difficulty of the operation
Tijdsspanne: from skin incision to wound closure
Measured by the number of operative field clearance using gauze to make the remained procedure convenient
from skin incision to wound closure
Incidence of transfusion
Tijdsspanne: within 2weeks after surgery
The incidence of allogenic or autologous (preoperative autologous blood donation) transfusion after surgery due to significant hemoglobin drop within 2weeks after surgery
within 2weeks after surgery
Wound complications
Tijdsspanne: on the 2nd and 14th day after surgery
wound complications evaluated on the 2nd and 14th day after surgery, such as ecchymosis, subcutaneous hematoma, hemarthrosis, and oozing
on the 2nd and 14th day after surgery
Thigh complications
Tijdsspanne: within 2 weeks
Thigh complication due to the tourniquet, such as ecchymosis, skin bullae, and skin necrosis around the area of tourniquet application
within 2 weeks
Venous thromboembolism
Tijdsspanne: within 2 weeks
symptomatic deep vein thrombosis and pulmonary embolism, detected within 2weeks after surgery
within 2 weeks
Postoperative pain (VAS)
Tijdsspanne: on the 2nd and 5th day after surgery.
An independent investigator who was blinded to randomization assessed knee and thigh pain level using 0 to 10 visual analog scale (VAS) that ranged from 0 (no pain) to 10 (worst imaginable pain) on the 2nd and 5th day after surgery.
on the 2nd and 5th day after surgery.
More painful site
Tijdsspanne: on the 2nd and 5th day after surgery
An independent investigator who was blinded to randomization assessed the more painful site either knee (operation site) or thigh (tourniquet application site) on the 2nd and 5th day after surgery.
on the 2nd and 5th day after surgery
More painful side in SBTKA
Tijdsspanne: on the 2nd and 5th day after surgery.
An independent investigator who was blinded to randomization assessed the more painful side in patients undergoing simultaneous bilateral TKA (SBTKA), whose each knee will be allocated into experimental and control group, respectively.
on the 2nd and 5th day after surgery.
Amount of drainage
Tijdsspanne: Until the drainage removal, average of 1 to 2 days after surgery
Total amount of subcutaneous indwelled drainage before removal of it.
Until the drainage removal, average of 1 to 2 days after surgery
Hemoglobin drop on the 2nd day after surgery
Tijdsspanne: On the 2nd day after surgery
The hemoglobin drop calculated by subtracting hemoglobin level of postoperative 2nd day from the preoperative value
On the 2nd day after surgery
Hemoglobin drop on the 5th day after surgery
Tijdsspanne: On the 5th day after surgery
The hemoglobin drop calculated by subtracting hemoglobin level of postoperative 5th day from the preoperative value
On the 5th day after surgery

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

Seoul National University Hospital

Onderzoekers

  • Hoofdonderzoeker: Tae Kyun Kim, MD, PhD, Joint Reconstruction Center, Seoul National University Bundang Hospital

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start

1 februari 2013

Primaire voltooiing (Verwacht)

1 december 2014

Studie voltooiing (Verwacht)

1 januari 2015

Studieregistratiedata

Eerst ingediend

20 februari 2013

Eerst ingediend dat voldeed aan de QC-criteria

15 april 2013

Eerst geplaatst (Schatting)

16 april 2013

Updates van studierecords

Laatste update geplaatst (Schatting)

20 mei 2014

Laatste update ingediend die voldeed aan QC-criteria

18 mei 2014

Laatst geverifieerd

1 mei 2014

Meer informatie

Termen gerelateerd aan deze studie

Trefwoorden

Aanvullende relevante MeSH-voorwaarden

Andere studie-ID-nummers

  • B-1206/158-004

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