Tourniquet-free minimally invasive TKA associated with aseptic loosening at 2 years
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CHICAGO — Patients who undergo tourniquet-free minimally invasive total knee arthroplasty may be at increased risk for revision due to aseptic loosening, according to presented results.
“Tourniquet-free TKA has been promoted in recent years due to evidence that it reduces ischemic tissue injury, decreases postoperative pain, swelling [and] opioid consumption, [and] preserves quadriceps strength,” Jennifer A. Kunes, BA, said in her presentation at the American Academy of Orthopaedic Surgeons Annual Meeting. “With minimally invasive (MIS) TKA, which is performed in a semi-flexed position, more bleeding can easily displace cement and lead to less visualization of the surgical field.”
Kunes and colleagues at Columbia University performed a retrospective, case-control study for 115 patients who underwent MIS TKA without a tourniquet and 258 patients who underwent MIS TKA with a tourniquet from October 2016 to May 2019. According to the abstract, MIS-TKA entailed cutting the tibia in extension with a low-profile femoral cutting device and the use of low-viscosity bone cement.
Outcome measures were assessed by 2-year follow-up and included revision surgery, radiolucent lines (RLL), WOMAC pain scores and complications. Researchers also analyzed aseptic loosening, which was defined as progressive radiolucent lines or circumferential lucency of greater than 2 mm, according to the abstract.
Overall, the tourniquet cohort had “significantly decreased” estimated blood loss (EBL) compared with the tourniquet-free cohort. Nine patients (7.83%) in the tourniquet-free cohort had aseptic loosening, while two patients (0.78%) in the tourniquet cohort had aseptic loosening. Six patients (5.22%) in the tourniquet-free cohort have since undergone revision surgery for aseptic loosening, while no patients in the tourniquet cohort were revised. No differences were found between the cohorts in all-cause revisions or RLL for the femoral component or the tibial component.
“In summary, we found that tourniquet-free MIS TKA was associated with an increased risk of aseptic loosening, increased risk of radiolucent lines and EBL,” Kunes concluded. “It is worth noting here that the surgeon in this study did go back to using tourniquets after the study period,” she added.
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Kunes JA, et al. Paper 009. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting. March 22-26, 2022; Chicago.
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