What is Tourniquet-less Knee Replacement?
Tourniquet-less knee replacement surgery involves performing the procedure without applying a pneumatic tourniquet to restrict blood flow to the surgical site. The aim is to allow for better soft tissue perfusion during surgery, reducing the risk of tissue ischemia and postoperative complications.
In a traditional knee replacement, the tourniquet is inflated around the upper thigh to limit blood flow to the knee area. While this provides a bloodless field that aids surgical precision, it also temporarily cuts off blood flow, which may result in muscle damage, nerve injury, and increased postoperative pain once the tourniquet is removed.
Indications for Tourniquet-less Knee Replacement
The procedure may be indicated for individuals with compromised blood flow or vascular issues as avoiding a tourniquet can reduce the risk of complications related to blood circulation.
Procedure of Tourniquet-less Knee Replacement
The procedure for a tourniquet-less knee replacement is as follows:
- Preoperative Preparation: After a thorough physical evaluation and laboratory investigations to support the suitability for the surgery, you will be administered anesthesia (general or spinal). The surgical area is then sterilized, and you are positioned to allow the surgeon easy access to your knee joint.
- Incision: A vertical incision is made along the front of the knee to expose the damaged joint. Unlike traditional surgery, no tourniquet is applied to restrict blood flow during the procedure.
- Blood Loss Management and Removal of Damaged Tissue: Since no tourniquet is used, blood loss is controlled using other methods such as antifibrinolytics and electrocautery surgical techniques which seal blood vessels during the procedure. The surgeon then carefully removes the damaged or arthritic parts of the knee joint, including worn-out cartilage and bone, while preserving the healthy surrounding tissues.
- Preparation for Implant: The bones (femur, tibia, and sometimes the patella) are shaped to fit the knee replacement implants. Trial implants are placed to ensure the correct size and alignment.
- Insertion of the Prosthesis and Closure: The final implants, typically made of metal and plastic, are cemented or press-fitted into the bone. The surgeon ensures that the new knee joint has proper alignment, balance, and movement.
- Closure: The surgical site is irrigated to remove any debris or excess blood. The incision is then closed with sutures or staples and covered with a dressing.
Postoperative Care and Rehabilitation after Tourniquet-less Knee Replacement
Postoperative care and rehabilitation for tourniquet-less knee replacement includes:
- You are moved to the recovery room, where vital signs are monitored.
- Blood loss is managed post-surgery using drains, if necessary.
- Pain management is prioritized, with less reliance on strong painkillers due to reduced muscle damage.
- Early mobility is encouraged, often within 24 hours, to facilitate recovery.
- Physical therapy aims to help you regain strength, mobility, and function in the knee.
Benefits of Tourniquet-less Knee Replacement
The benefits of tourniquet-less knee replacement surgery include:
- Less Pain: You may experience less pain after surgery, especially in the muscles around the knee.
- Better muscle function: Without a tourniquet, there's less risk of muscle damage, leading to better movement and strength after surgery.
- Faster Recovery: There is quicker recovery and return to normal activities.
- Lower risk of Complications: There's a reduced risk of blood clots, nerve injury, and swelling, which are sometimes linked to tourniquet use.
- Less need for Pain Medication: Since there's less pain, you may often need fewer painkillers, thus lowering the risk of medication side effects.
Complications of Tourniquet-less Knee Replacement
Some of the potential complications of tourniquet-less knee replacement surgery involves:
- Increased blood loss
- Longer surgery time
- Increased risk of infection
- Implant failure
- Delayed wound healing
- Development of blood clots (DVT)
