Faster recovery without the use of a tourniquet in total knee arthroplasty

Abstract

Background and purposeTourniquet application is still a common practice in total knee arthroplasty (TKA) surgery despite being associated with several adverse effects. We evaluated the effects of tourniquet use on functional and clinical outcome and on knee range of motion (ROM).Patients and methods70 patients who underwent TKA were randomized into a tourniquet group (n = 35) and a non-tourniquet group (n = 35). All operations were performed by the same surgeon and follow-up was for 1 year. Primary outcomes were functional and clinical outcomes, as evaluated by KOOS and knee ROM. Secondary outcomes were intraoperative blood loss, surgical time and visibility, postoperative pain, analgesic consumption, and transfusion requirements.ResultsPatients in the non-tourniquet group showed a better outcome in all KOOS subscores and better early knee ROM from surgery to week 8. No difference was detected at the 6- and 12-month follow-ups. Postoperative pain and analgesic consumption were less when a tourniquet was not used. Surgical time and visibility were similar between groups. Intraoperative blood loss was greater when not using a tourniquet, but no postoperative transfusions were required.InterpretationThis study shows that TKA without the use of a tourniquet results in faster recovery in terms of better functional outcome and improved knee ROM. Furthermore, reduced pain and analgesic use were registered and no intraoperative difficulties were encountered.

Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

“…Quicker ability to achieve this activity was observed in subjects in whom a tourniquet was not used. Ejaz et al [14] [33] in a similar comparative study found no differences in Oxford knee scores at 10 weeks after TKA. To our knowledge, there is no agreed-upon clinically important difference in quadriceps strength for this population.…”

“…Increased intraoperative blood loss was observed when a tourniquet was not used, but no statistical differences were found in total (intraoperative + postoperative) blood loss between the tourniquet and no-tourniquet groups. Review of the literature shows the majority of studies confirm that intraoperative blood loss is greater if a tourniquet is not used [3,11,14,17,19,22,28,29,45,49,56,58,60,65]. Reports analyzing total blood loss are conflicting with some demonstrating no differences with or without tourniquet use [1,29,49,58], whereas others demonstrate reduced [3,54] or increased [28,58] total blood loss if a tourniquet is used.…”

“…Numerous reports have found lower levels of pain when a tourniquet is not used [1,11,14,27,56]. Others have observed pain is greater with higher tourniquet inflation pressure [59,63].…”

“…Advantages of tourniquet use include improved visualization, reduced intraoperative blood loss, and enhancement of cement fixation [11,14,17,21,22,27,45,54]. Reported adverse effects of tourniquet use include reduced early knee flexion [11,14,60,62,65], increased perioperative pain [11,14,27,56], postoperative limb swelling [11,21,47], wound complications [9,12,40,41], and creation of cardiac and cerebral microemboli [16,20,[42][43][44]55]. Additionally, some have reported an increased incidence of deep venous thrombosis [8,57,65], arterial thrombosis in subjects with preoperative vascular disease [26,48,49], and peripheral nerve injury [28,39].…”

“…Application of a tourniquet during TKA has been frequently used to improve visualization of the operative field, decrease intraoperative blood loss [11,14,17,22,27,60,65], and improve the quality of cementation by providing a relatively bloodless operative field [21]. A 2010 analysis of current practice patterns of members of the American Association of Hip and Knee Surgeons found 95% of patients without vascular disease who underwent TKA had their procedures performed under tourniquet control [7].…”