Abstract:
BACKGROUND:The use of the tourniquet in total knee arthroplasty is still a subject of controversial discussion. Previous studies mainly focus on parameters like blood loss and operation time. The aim of this systematic review is to evaluate the postoperative outcome involving parameters such as pain intensity, analgesic consumption, knee function and complication rate with and without tourniquet use, to find a recommendation for future application in total knee arthroplasty. MATERIAL AND METHODS:This review is based on the PRISMA Checklists. A systematic research was performed in PubMed using the key words "tourniquet", "total knee arthroplasty", "TKA" and "knee endoprosthesis" up to and including January 2018. The initial search revealed 686 Papers which were extracted by the parameters intensity of pain, analgesic consumption, function (range of motion, Hospital for Special Surgery Score, Knee Society Score) and complications (deep vein thrombosis, surgical side infection, pulmonary embolism). The program Review Manager Version 5.3 was used for statistical analysis. A significance level of p < 0,05 was defined. RESULTS:18 studies were included in this review with 1279 total knee arthroplasties overall (646 with the use of tourniquet and 633 without). The analysis shows a significant lower pain intensity until the fifth postoperative day (p = 0,03) and also after one to three months (p = 0,04) without using the tourniquet. Range of motion is significantly higher in two to three days postoperatively (p < 0,00 001) when the surgery was performed without tourniquet. Knee Society Score shows no difference between the two groups. A deep vein thrombosis appears significantly more often when using a tourniquet (p = 0,04). There was no higher occurrence in pulmonary embolism and surgical side infections. CONCLUSION:The use of a pneumatic tourniquet in total knee arthroplasty affects especially the early postoperative pain and functional recovery. HINTERGRUND:Der Einsatz einer Blutsperre bei der Implantation von Knietotalendoprothesen wird in der Literatur kontrovers diskutiert. Bisherige Übersichtsarbeiten konzentrieren sich vor allem auf die Parameter Blutverlust und Operationszeit. Ziel der vorliegenden Metaanalyse hingegen ist es, das postoperative Ergebnis anhand der Parameter Schmerzintensität, Analgetikabedarf sowie Funktion des Kniegelenks und Komplikationsrate nach der Implantation einer Knietotalendoprothese mit und ohne Anwendung der Blutsperre zu analysieren. METHODEN:Zur Erstellung dieser Arbeit wurden die PRISMA-Checklisten angewandt. Es erfolgte eine systematische Literaturrecherche mithilfe der PubMed-Datenbank anhand der Suchbegriffe „tourniquet“, „total knee arthroplasty“, „TKA“ und „knee endoprosthesis“ bis einschließlich Januar 2018. Analysiert wurden insgesamt 686 Manuskripte hinsichtlich der Parameter Schmerzintensität, Analgetikabedarf, Funktion (Bewegungsausmaß, Hospital for Special Surgery Score und Knee Society Score). Bei den Komplikationen wurden das Auftreten tiefer Beinvenenthrombosen, Wundinfektionen und Lungenembolien untersucht. Zur statistischen Analyse diente das Programm Review Manager Version 5.3. Ein p-Wert von < 0,05 wurde als Signifikanzniveau festgelegt. ERGEBNISSE:Es konnten 18 Studien mit insgesamt 1279 Knietotalendoprothesen eingeschlossen werden, davon 646 mit und 633 ohne Anwendung einer Blutsperre. Die Analyse ergab bis zum 5. postoperativen Tag eine signifikant niedrigere Schmerzintensität (p = 0,03) und ebenfalls nach 1 – 3 Monaten (p = 0,04) bei der Implantation ohne Blutsperre. Beim Bewegungsausmaß war in den ersten 2 – 3 Tagen postoperativ ein signifikanter Unterschied (p < 0,00001) zugunsten der Operation ohne Blutsperre nachzuweisen; bei dem Knee Society Score ergab sich zu keinem Zeitpunkt eine Differenz zwischen den beiden Gruppen. Eine tiefe Beinvenenthrombose trat signifikant häufiger auf, wenn mit Blutsperre operiert wurde (p = 0,04). Bei der Häufigkeit einer Lungenembolie oder einer oberflächlichen Wundinfektion gab es keinen Unterschied. SCHLUSSFOLGERUNG:Eine Blutsperre bei einer Implantation von Knietotalendoprothesen zu verwenden, beeinflusst vor allem die frühen postoperativen Schmerzen und die funktionelle Rehabilitation negativ.
journal_name
Z Orthop Unfalljournal_title
Zeitschrift fur Orthopadie und Unfallchirurgieauthors
Jawhar A,Skeirek D,Stetzelberger V,Obertacke Udoi
10.1055/a-0983-3808subject
Has Abstractpub_date
2020-12-01 00:00:00pages
630-640issue
6eissn
1864-6697issn
1864-6743journal_volume
158pub_type
杂志文章abstract:BACKGROUND:In the late 1960s, the helicopter emergency medical service (HEMS) was established in Germany because of an increasing number of severe injuries in traffic accidents. To get a doctor quickly on scene was the initial intention, rather than transporting the patient. Today, rescue helicopters cover the entire f...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-0035-1545801
更新日期:2015-08-01 00:00:00
abstract::In the history of evolution, the human foot is the youngest part of our skeleton and allows plane bipedal walking due to development of a longitudinal and transverse arch of the foot, with a stable, parallel first ray, but sacrificing the ability to grasp. Due to the loss of grasping, the hominoid mothers had to lay d...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/a-0661-6250
更新日期:2019-02-01 00:00:00
abstract:INTRODUCTION:Automatic power-operated windows of modern motor vehicles present a risk of injury due to jam events. CASE REPORT:A 41-year-old man suffered an injury of his gingiva upon jamming of his face between the window and seal entry. The motor vehicle window that led to the injury had no closing force restriction...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-0032-1327797
更新日期:2012-12-01 00:00:00
abstract:AIM:This study investigated the fusion properties of a new intervertebral spacer that is directly fixed to the adjacent vertebrae by screws. The new spacer was compared with an identical spacer without direct fixation but with an additional plate and with an autologous bone graft. METHODS:A single-level, cervical fusi...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-2007-965798
更新日期:2007-11-01 00:00:00
abstract::The reasons for delayed fracture healing or non-union formation are multifactorial. Mechanical factors are well known to influence the process of fracture healing. However, there is a lack of knowledge about the biological conditions that have to be achieved for adequate bone healing. Treatment of non-unions is still ...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章,评审
doi:10.1055/s-0035-1546146
更新日期:2015-10-01 00:00:00
abstract:INTRODUCTION:Trauma or infectious diseases can cause destruction of the epiphyseal region of the knee with premature partial bridging of the physis and deviation of length and axis. There is only little information about tumorous lesions as pathogenetic factor for these deviations. We have been searching for an approac...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-2008-1038999
更新日期:2008-11-01 00:00:00
abstract::Bone sarcomas are extremely rare representing approximately 0.2% among all cancer types. Due to the rarity of these tumors both the patients and the physicians can overlook or misinterpret the first often unspecific symptoms of these tumors (pain, limping and swelling). Therefore, radiographic examination (X-ray and/o...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章,评审
doi:10.1055/s-0043-117905
更新日期:2018-02-01 00:00:00
abstract:BACKGROUND:Osteochondral lesions (OCL) of the talus show a distinct distribution pattern. Vascular, metabolic, idiopathic, and biomechanical factors have been proposed as influencing factors. However, the association of hindfoot alignment and the location of talar OCL is not known. MATERIALS AND METHODS:In 22 patients...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-0034-1368604
更新日期:2014-08-01 00:00:00
abstract:BACKGROUND:Realisation of a major operation of tumours/metastases in the backbone is in many cases not possible, above all in older multimorbid patients with higher OP risks. So it is important to proceed here so minimally invasive as possible, but at least actually to reduce above all pain for the patient and the dang...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-0034-1382936
更新日期:2014-10-01 00:00:00
abstract::In contrast to periprosthetic fractures of the femur, periprosthetic fractures of the acetabulum are rare complications - both primary fractures and fractures in revision surgery. This topic is largely under-reported in the literature; there are a few case reports and no long term results. Due to an increase in life e...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章,评审
doi:10.1055/s-0042-113196
更新日期:2016-12-01 00:00:00
abstract:AIM:The aim of this study was to investigate hyaline cartilage defects treated with cell-seeded artificial matrix systems (two different collagen type I gels) with the method of optical coherence tomography (OCT) and to correlate the results with conventional histological and immunocytochemical staining. METHOD:Osteoc...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-2008-1038948
更新日期:2008-11-01 00:00:00
abstract:AIM:The aim of this study was to make a mid-term evaluation of an unconstrained pyrocarbon prosthesis (Ascension®) in the treatment of idiopathic degenerative arthritis of the proximal interphalangeal joint of the hand. METHOD:13 implants (10 patients) were clinically and radiologically studied after a follow-up perio...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 临床试验,杂志文章
doi:10.1055/s-0031-1298389
更新日期:2012-06-01 00:00:00
abstract::The primary objective of osteomyelitis treatment is disinfection. Therapies can be protracted and expensive. The basic approach is to use radical debridement with antibiotics. However, radical debridement often results in major osseous defects, so it may be necessary to restore bone structures. Several different thera...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-0042-100737
更新日期:2016-04-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to evaluate long-term clinical and radiological results as well as survival rates of the NexGen® CR posterior cruciate retaining prosthesis. PATIENTS AND METHODS:We evaluated a consecutive series of 761 total knee replacements performed on 716 patients from 1999 to 2001 at our ...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 临床试验,杂志文章
doi:10.1055/s-0035-1546040
更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:Currently, there is a need for scientific evidence on the efficacy of classical massage therapy for chronic, unspecific back pain, especially for the improvement in functional impairment and long-term pain reduction. According to the National Health Care Guidelines, classical massage for nonspecific low back...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章,随机对照试验
doi:10.1055/a-0715-2332
更新日期:2019-06-01 00:00:00
abstract::During the last years, the prosthetic replacement in upper limb amputees has undergone different developments. The use of new nerve surgical concepts improved the control strategies tremendously, especially for high-level amputees. Technological innovation in the field of pattern recognition enables the control of mul...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章,评审
doi:10.1055/s-0042-108910
更新日期:2016-08-01 00:00:00
abstract:AIM:Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder arising from synovial cells of the tendon sheets and joint capsules. The potential value of external beam radiation therapy in the interdisciplinary management of PVNS is demonstrated by a comprehensive literature review on the clinical use of...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章,meta分析,评审
doi:10.1055/s-0030-1250687
更新日期:2011-12-01 00:00:00
abstract::Background: The perception of back pain subjective is hard for physicians to measure. For this reason, questionnaires are an important instrument to evaluate the pain 1. The main point of this study was to verify differentiation of pain symptoms in patients with different pain mechanisms. The most important parameter ...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-0042-108063
更新日期:2016-12-01 00:00:00
abstract::A young woman had subcutaneous bleeding at the retinaculum of the left knee after minor trauma. A small vein was attached to the scar and repeatedly ruptured after several other small traumas. Conservative therapy had no impact on the genesis of the bleeding. Having gone through severe bleeding situations with massive...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-0029-1240786
更新日期:2010-09-01 00:00:00
abstract:BACKGROUND:Cement leakage is regarded as a typical complication of cement-based augmentation of vertebral fractures. The gold standard is balloon kyphoplasty (BK). Recent methods, such as radiofrequency kyphoplasty (RFK), must be compared with BK in terms of therapeutic success and complication rates. It is unclear whe...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章,随机对照试验
doi:10.1055/s-0042-104069
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to evaluate the impact of students preexisting anatomic proficiency to address the fundamental problems related to musculoskeletal ultrasound (MSUS) training by assessing the peer-assisted learning (PAL) system. METHODS:Students without anatomic knowledge (first semester, n = 38) an...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-0030-1250378
更新日期:2010-12-01 00:00:00
abstract::Injuries to the lateral ankle ligaments are the most common sports injuries. Determination of their severity and exclusion of relevant accompanying injuries requires a subtle clinical and a focussed radiological assessment. Treatment is non-operative and functional in the majority of cases. Consequent application of o...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章,评审
doi:10.1055/s-0031-1280258
更新日期:2011-10-01 00:00:00
abstract:BACKGROUND:Tibial tubercle avulsion fractures are rare, they represent less than 1% of all physeal fractures. Compared to monolateral tibial tubercle avulsion fractures, bilateral occurrence is even rarer. The purpose of this study is to report about the so far largest group of bilateral avulsion fractures and to compa...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/a-0979-2384
更新日期:2020-10-01 00:00:00
abstract:INTRODUCTION:Lawn mower injuries in children usually involve the lower extremities and can lead to serious amputation injuries. Treatment should look not only at the acute reconstruction, but also on maintaining the ability to grow. We report the case of a two-year-old boy with amputation of the heel. CASE REPORT:The ...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-0031-1298260
更新日期:2012-04-01 00:00:00
abstract:BACKGROUND:The design and the surgical technique of the Silent Micro Hip™ are different compared to other hip stems due to a conical shape for fixation within the metaphyseal femur. The purpose of the present study was to evaluate hip joint biomechanics of the Silent Micro Hip™ in comparison to other implants. Implant-...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-0033-1350862
更新日期:2013-10-01 00:00:00
abstract::The number of patients with meniscal injuries is increasing constantly, but the treatment algorithms are undergoing continuous change. The effects of meniscal surgery, as well as the indications for the procedure, are currently a matter of heated debate. Various German speaking associations addressing topics related t...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章,评审
doi:10.1055/s-0042-116683
更新日期:2017-04-01 00:00:00
abstract::Cement-augmented pedicle screws can increase the stability of fixators for unstable vertebral fractures in the elderly. Fixators can be inserted quickly and with minimally invasive techniques, reducing surgical risks. From March 2012 until July 2014, we treated 40 patients with percutaneous augmented fixators for unst...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章
doi:10.1055/s-0043-111594
更新日期:2017-10-01 00:00:00
abstract:AIM:The aim of this study was to compare the different diagnostic features (symptoms, physical examination, radiographic features and intraoperative findings) of osteoarthritis of the knee before total joint replacement and consequently relate them with each other. METHOD:Patients with primary osteoarthritis of the kn...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 临床试验,杂志文章
doi:10.1055/s-2007-965550
更新日期:2007-07-01 00:00:00
abstract:AIM:Dynamic gait analysis of blocked distal tibiofibular joint (TFJ) has not performed yet. This prospective study investigated patients treated for ankle fractures with combined syndesmotic complex lesions after surgery including tibiofibular positioning screw using CT data detecting fibular maltorsion and dynamic gai...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 临床试验,杂志文章
doi:10.1055/s-0029-1185695
更新日期:2009-07-01 00:00:00
abstract::In Germany and other European countries, cancer is the second most common cause of death after cardiovascular disease. Although 5-year survival rates for several types of cancer have significantly improved over the last 30 years, metastasis to the bone almost always leads to incurable disease. Aside from the rare prim...
journal_title:Zeitschrift fur Orthopadie und Unfallchirurgie
pub_type: 杂志文章,评审
doi:10.1055/s-0043-116799
更新日期:2017-12-01 00:00:00