Discussion
Thrombotic, blood loss, intraoperative hemorrhage, nonthrombotic, infections, anemia, DVT, pain, thrombotic, bruising, TKA, blisters, Postoperative hemorrhage
THROMBOTIC, PULMONARY EMBOLISM, POSTOPERATIVE COMPLICATIONS, BLOOD LOSS, INTRAOPERATIVE HEMORRHAGE, INFECTIONS, ANEMIA, HYPOXIC, EVENTS, POSTOPERATIVE HEMORRHAGE, COMPLICATIONS, DVT
The results of this study showed that patients in both the tourniquet and nontourniquet groups had the lowest postoperative hemoglobin levels from postoperative Days 3 to 7. In 47 patients, the lowest hemoglobin level was on postoperative Day 3 or 7, accounting for 94% of all patients. Postoperative hemorrhage gradually improves at 72 h after TKA, and patients often have the lowest hemoglobin level from postoperative Days 3 to 7. Thus, surgeons should pay attention during this period to ensure perioperative safety, especially for patients with mild anemia before surgery. Our study showed that tourniquet use in TKA had no significant effect on blood loss or the blood transfusion rate compared with nontourniquet use. A possible explanation is that hemostasis must be more meticulous and effective when a tourniquet is not used [We typically use tourniquets during surgery. Tourniquet use reduces intraoperative hemorrhage and provides a clear surgical advantage for TKA; thus, it should theoretically aid surgeons in reducing the length of the operation [The postoperative complications of TKA can be classified as thrombotic and nonthrombotic events. Thrombotic events include DVT and pulmonary embolism, whereas other complications are classified as nonthrombotic events. The results of our study showed that the overall complications and thrombotic and nonthrombotic events in the two groups were not significantly different. However, the tourniquet group had a significantly higher rate of local complications at the site of the affected limb, such as thigh bruising, blisters, pain, fat liquefaction, and superficial infections. Despite no significant difference, the incidence of local complications in the tourniquet group (36%), which was twice as high as that in the nontourniquet group (16%), should be taken into consideration. Direct tourniquet pressure on the thigh can cause local complications. Wound complications may be caused by hypoxic conditions due to tourniquet use, resulting from insufficient oxygen supply for wound healing and angiogenesis, as well as decreased macrophage and fibroblast migration [In this study, the incidence rate of thrombotic events was 6%, which was lower than that of 40% reported for the Asian population [Whether nontourniquet use affects prosthesis fixation or causes loosening of the prosthesis is the most concerning issue. No current evidence exists indicating that surgery without tourniquet use affects the long-term survival of the prosthesis [The clinical relevance of this study lies in the fact that although the use of tourniquets in TKA is still a controversial topic and there is no standard conclusion, the results of this study provide a reference for joint surgery clinician choice. Therefore, joint surgeons can choose to use tourniquets according to their own preferences, but when using tourniquets, certain measures need to be taken to reduce the occurrence of local complications.The cost-effectiveness analysis of this study mainly focuses on the length of hospital stay and its medical expenses. The two groups of patients had similar outcomes in terms of blood loss, operation time and drainage volume. However, the incidence of local complications in the nontourniquet group was significantly lower than that in the tourniquet group. Local complications caused by the use of tourniquets may prolong the patient’s hospitalization time and increase corresponding medical expenses. In addition, as tourniquets require additional medical equipment (tourniquets and inflatable pumps), from this perspective, the cost-effectiveness ratio of not using tourniquets is better.The main advantage of this study is that it was a randomized controlled study, and the difference between the two treatment group interventions (using or not using tourniquets) is simple and clear.Our study also has limitations. This was a single-center randomized controlled study, the number of cases was limited, and our follow-up time was short, with possible errors in the statistical results. We will carry out multicenter large sample size research in future work to improve the quality of our research.