Reducing Tourniquet Time During Total Knee

Replacement Offers Post-Operative Benefits for Patients

As the population of the United States ages, knee replacements have become more and more common. In fact, it is estimated that by 2030, almost 3.5 million adults in the US will receive a knee replacement each year. Surgery is usually the final option after patients with osteoarthritis have tried anti-inflammatory medications and physical therapy without getting the relief they need.

When patients receive a total knee replacement, many factors can affect their recovery. One that isn’t widely known is the surgeon’s use of a tourniquet during the procedure.

“The modern version of a tourniquet is not that different from what you’ve probably seen on TV,” explained Dr. John Xenos, an orthopedic surgeon at Sky Ridge Medical Center who performs total knee replacements. “It may look a little different, but the concept is the same. You wrap it around the patient’s thigh and apply pressure to muscles.”

Tourniquets have been used for centuries. They are the most common method of bleeding control during total knee replacement. By applying severe pressure around the thigh using a tourniquet, surgeons can minimize the flow of blood to the knee.

When using a tourniquet, doctors are able to perform the surgery with very little blood in the surgical field, which improves visibility. “There are major benefits to using a tourniquet,” said Dr. Xenos. “But I’ve seen firsthand that there are a lot of complications, too.”

Based on clinical studies, some of the complications resulting from using a tourniquet include thigh pain, swelling and bruising. In contrast, minimizing tourniquet time has been shown to reduce pain, swelling and bruising after surgery, and has been associated with greater range of motion. It has also been shown to reduce the risk of other post-operative complications like wound infection, nerve injury, internal pooling of blood (called hematoma), blood clots, and deep vein thrombosis (DVT).

“There are other methods of bleeding control available besides a tourniquet,” said Dr. Xenos, who now uses the Aquamantys® Bipolar Sealer to control bleeding during his knee replacements. “As soon as I saw the benefits, I immediately adopted it in my practice.”

“There are other methods of bleeding control available besides a tourniquet,” said Dr. Xenos, who now uses the Aquamantys® Bipolar Sealer to control bleeding during his knee replacements. “As soon as I saw the benefits, I immediately adopted it in my practice.”

Created by Medtronic, the Aquamantys handpiece plugs into a radiofrequency energy generator and provides hemostasis (the stopping of blood flow) during surgery. The doctor touches the electrodes of the handpiece to the tissue. The handpiece emits a combination of heat and saline that causes the bleeding to stop.

“Using the Aquamantys reduces blood loss, but there are also many important patient benefits,” stated Dr. Xenos. Some of the study results that have been shown with using Aquamantys devices during knee replacement include reduced blood loss, lower transfusion rates, higher postoperative hemoglobin levels, and less drainage output when compared to traditional electrosurgery.

“By eliminating the use of a tourniquet and replacing it with the Aquamantys System, I feel like I’m giving the best care to my patients who need a knee replacement.”