Every year a lot of studies are published on tourniquet time and blood loss and outcome after TKA. I do not use a tourniquet at any time of the TKA procedure. I am interested in conducting a study to assess quad muscle function and outcome of TKA without using a tourniquet.
Dear Rene Attal,
in my opinion a loss of blood supply should generate a reduced endurance of the tissues especially the muscles so it should be possible to use a test that involves repeated maximal contractions you could find lots of great articles from
Michael Bade (a ResearchGate member).
Hoping it is useful to you
good luck with your research
Dr. Rene Attal,
The clinical trials on TKA with or without tourniquet are numerous but controversial (s. below). In any case if you are looking for some pathologic/histologic impairments of quadriceps muscle as sequelae of the use of tourniquet, it can be a good idea. However, I do not believe there are such changes if the tourniquet is not used for more than 60 minutes.
Regards
http://www.boneandjoint.org.uk/highwire/filestream/39835/field_highwire_article_pdf/0/30.full-text.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116117/
http://www.josr-online.com/content/9/1/13
Dear Rene Attal,
I think that article could be useful to you!
Harsten, A. 2015 Tourniquet versus no tourniquet on knee-extension strength early after fast-track total knee arthroplasty; a randomized controlled trial
Knee
Have a nice day!
Giacomo
If you are looking at early recovery/impairment in your proposed study, serial daily EMGs could be the answer you are looking for. There are no definite answers for late assessment, as yet.
There are several studies for and against the use of Tourniquet in TKA and some studies have taken a neutral stand.
I have been using tourniquet regularly for TKA patients since 15 years, generally not exceeding 90 minutes. I personally know few surgeons who use tourniquet upto 120 minutes in revision cases without any problems.
The muscle damage (?) produced by tourniquet is questionable, the strength gain achieved by non usage may be of help in the first one or two weeks after TKA.
But muscles are re-educatable and trainable, the power can be regained in short time after tourniquet use. More important issue is : what was the muscle strength/power before surgery? What was the capacity of mobility before surgery?
For me, tourniquet gives a clean dry field, makes surgery faster.The blood splashing during various steps : soft tissue releases, bone cuts, trialing etc is less. Cementing is superior. In elderly patients, especially with cardiac ailment, anesthesiologist may not prefer "hypotensive" anesthesia which is often used with non-tourniquet use.
I THINK it depends on tourniquet time and pressure and it is a transient problem.
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