Background Bilateral total knee arthroplasty (TKA) for bilateral knee repair has many advantages. It is cost effective and allows for rehabilitation under a single admission. However, bilateral TKA is a more aggressive procedure than unilateral TKA. Furthermore, complications of pulmonary embolism (PE) occur at a greater frequency than with unilateral TKA, and blood transfusion is often necessary. We retrospectively studied a series of patients and prospectively investigated the prevention of PE.
Methods Between 1997 and 2000,113 patients underwent primary bilateral TKA via a cementless procedure at our hospital. From May 2000, all patients underwent bilateral TKA without a tourniquet. Patients were categorised into four groups, and the incidence of PE was determined.
In Group1 and 2, respectively, RA patients underwent TKA with or without a tourniquet. In Group3 and 4, respectively, OA patients underwent TKA with or without a tourniquet.
The diagnosis of PE was made by lung perfusion scintigraphy as respiratory failure, and blood loss was assessed after TKA according to the decline in haemoglobin (HB).
Blood loss = Total Blood Volume (TBV) = (1-HB postope/HB preope).
We analysed all patient-related variables using a chi-squared test.
Results The incidence of PE was 21.1% in Group1 (8/38), 0.0% in Group 2 (0/3), 23.6% in Group 3 (13/55), and 0% in Group 4 (0/17).
The incidence of PE did not differ significantly between RA and OA.
For surgery without a tourniquet, the incidence of PE in Group 2 and Group 4 was significantly lower than for surgery with a tourniquet (p = 0.0185).
Mean calculated blood loss was 988 ml in Group 1, 1091 ml in Group 2, 1421 ml in Group 3, and 1412 ml in Group 4.
However, the amount of blood loss did not differ significantly between surgery with a tourniquet and surgery without (p = 0.3083), but was significantly different between RA and OA (p < 0.0001).
Discussion We performed bilateral TKA without a tourniquet to reduce the risk of PE. Reported causes of PE in TKA include the use of a tourniquet and an intramedullary alignment system. When TKA was performed without a tourniquet, thrombosis and fat emboli did not flow into pulmonary arteries, and all emboli were expelled with extracorporeal bleeding.
The major problem associated with TKA without a tourniquet is blood loss, and few studies have examined the benefits of using a tourniquet. We estimated blood loss by calculating the decline of haemoglobin. The results suggested that blood loss did not differ significantly between tourniquet procedures and no tourniquet procedures.
Conclusion In conclusion, the possibility was suggested of preventing PE in TKA without the use of a tourniquet.
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