No effect of tourniquet in primary total knee arthroplasty on muscle strength, functional outcome, patient satisfaction and health status: a randomized clinical trial

Abstract

Purpose Tourniquet use during primary total knee arthroplasty (TKA) may negatively impact the early postoperative functional recovery due to molecular effects of ischaemia. The hypothesis of the present study was that primary TKA without a tourniquet positively influences the postoperative muscle strength, functional outcome, patient satisfaction and health status. Methods The monocentric, randomized, controlled trial included a total of 99 patients scheduled to undergo primary TKA (ClinicalTrials.gov NCT02475603). The patients were randomly assigned to the tourniquet (n = 50) or non‐tourniquet (n = 49) group after receiving a written informed consent. As primary outcome parameter, the functional outcome, patient expectation/satisfaction and the health status were assessed preoperatively, 6 weeks, 6 months postoperatively using Oxford knee score, WOMAC score, Mancuso score, EQ‐5D index, EQ‐VAS, anxiety score, depression score, hospital anxiety and depression scale, respectively. Additionally, a rope pulley isokinetic system (Moflex, Recotec/Bernina, Switzerland) was applied to quantify the muscle strength preoperatively, 1 week, 6 weeks and 6 months postoperatively. Results No difference in any of the outcome parameters could be observed between the groups at all time points after TKA (n.s.). Also the isokinetic muscle strength of the knee joint as quantified by concentric/eccentric peak force (N), workload (J), total workload (J) and power (W) did not reveal statistically significant differences between the groups and time points. However, in both groups improved results were found with respect to the functional outcome, patient satisfaction, health status and isokinetic muscle strength up to 6 months postoperatively. Conclusions The application of the tourniquet did not affect the isokinetic muscle strength, the functional outcome, the patient satisfaction and the health status following primary TKA. However, with and without tourniquet use, the level of the knee functionality, the patient satisfaction as well as the health status improved significantly. Level of evidence I.

Application of Tourniquet Does Not Influence Early Clinical Outcomes After Total Knee Arthroplasty

“…Although various randomized clinical trials have been published, the use of a tourniquet during total knee joint replacement has still been a topic of debate [15][16][17]. There is conflicting evidence regarding the effect of tourniquet use on perioperative blood loss and postoperative function and pain.…”

Lower total blood loss in total knee arthroplasty with a low-pressure tourniquet than without

“…Jahwar et al have recently shown in a prospective study no difference in functional outcome using or not a tourniquet for primary TKA (16) even with a high pressure of 360 mm Hg. Recovery after TKA is certainly more influenced by all perioperative measures than by the use or not of the tourniquet.…”

“…The inflate tourniquet-pressure is directly correlated to the rate of complications (5). It is therefore logical to suppose that decreasing the tourniquet-inflate pressure would decrease these complications, however very few papers have demonstrated this (16,17). Interestingly, lower tourniquet-inflate pressures used nowadays are certainly one of the reasons why recent studies show very different results from previous ones concerning TKA complications.…”

Safety of Total Knee Arthroplasty without Using a Tourniquet in Elderly Patients

“…Regarding perioperative blood loss, Jawhar et al also reported reduced intraoperative bleeding with the use of a tourniquet but no difference in total bleeding volume [ 16 ]. They also subsequently reported no difference in functional outcomes and patient-reported outcomes in the same cohort [ 19 ]. However, Hasanain et al reported that the use of a tourniquet reduced total bleeding without postoperative complications [ 20 ].…”