The effect of early tourniquet release on primary total knee arthroplasty and an analysis of risk factors for deep vein thrombosis.

BACKGROUND

The study aims to compare the effects of early release and the use of a tourniquet throughout the procedure on primary total knee arthroplasty (TKA), and to analyze which risk factors are associated with the occurrence of deep vein thrombosis (DVT) postoperatively.

METHODS

This retrospective study enrolled 335 patients who underwent unilateral primary TKA. The patients were stratified into the ET group (from the incision to the fixation of the prosthesis) and FT group (from the incision to closure) according to tourniquet time. Data collected included the Visual Analogue Scale (VAS), Knee Society Scores (KSS), intraoperative blood loss (IBL), total blood loss (TBL), transfusion, operative time, tourniquet time, thrombin-antithrombin complex (TAT) and plasmin-α2-antiplasmin complex (PIC) level, as well as the incidence of complications such as DVT.

RESULTS

The mean tourniquet time was 76.26 ± 6.94 min in the ET group and 107.70 ± 8.73 min in the FT group. The ET group exhibited comparable incidences of total DVT and complications, but a significantly lower incidence of proximal DVT and greater IBL. However, there were no significant differences between the two groups in VAS, KSS, TBL, transfusion, operation time, TAT and PIC level. Regression analysis showed that tourniquet time and postoperative TAT level were independent risk factors for DVT following TKA.

CONCLUSION

Early tourniquet release reduced the incidence of proximal DVT. Thus, shortening tourniquet time was recommended in clinical practice. The tourniquet time and postoperative TAT level can serve as important predictive indicators for DVT after primary TKA.