Background: While use of a tourniquet during total knee arthroplasty (TKA) can reduce tourniquet-related thromboembolic events are a concern. The purpose of this retrospective study was to explore the impact of tourniquet use on thromboembolic events in TKA patients with and without gastrocnemius vein dilation (GVD).
Methods: A total of 373 patients undergoing TKA were enrolled. All TKA cases were identified from the inpatient system database. Univariate analysis, multivariate logistic regression analysis and multivariate analysis of variance
(MANOVA) were used to compare difference between the DVT patients and the non-DVT patients.
Results: Among the 373 patients, 80 (21.4%) developed thrombosis events, including 73/373 (19.6%) isolated distal DVTs and 7/373 (1.9%) proximal DVTs; sixteen of these patients were symptomatic. Logistic regression analysis showed that older age [odds ratio (OR) = 1.087, P <0.001], varicose veins (OR = 2.946, P = 0.030), female gender (OR =2.155, P = 0.031), GVD (OR = 2.029, P = 0.012) and tourniquet (OR = 3.933, P <0.001) were significantly associated with postoperative DVT. For symptomatic DVT, older age (OR= 6.138, P = 0.024), GVD (OR = 8.197, P = 0.007) and tourniquet (OR = 1.106, P = 0.006) were found to be the predictor. The results of MANOVA showed that tourniquet significance increase thromboembolic events in patients with GVD (P = 0.005). However, there is no significant difference for symptomatic patients at present.
Conclusions: Tourniquet and GVD were the independent risk factors for total and symptomatic DVT patients after TKA. And tourniquet use may increase total DVT events in patients with GVD. Preoperative ultrasound examination may be beneficial in preventing postoperative DVT. And reducing the use of tourniquets should be considered for these GVD patients.