Tourniquet Use Does Not Affect Functional Outcomes or Pain After Total Knee Arthroplasty

Abstract

Background: The use of a tourniquet during total knee arthroplasty (TKA) is controversial. Pain and return to function are believed, by some, to be influenced by the use of a tourniquet. The hypothesis of this study was that use of a tourniquet would delay postoperative functional recovery and increase pain as compared with no tourniquet use. Methods: Two hundred patients were recruited for this prospective, double-blinded, randomized controlled trial. Patients were randomized to undergo TKA either with a tourniquet (100 patients) or without one (100 patients) and blinded to group allocation. Primary outcome measures were functional assessment testing using the Timed Up & Go (TUG) test and visual analog scale (VAS) pain scores. Secondary outcome measures included the stair-climb test, blood loss, surgical field visualization, and range of motion. Outcome measures were completed preoperatively, in the hospital, and postoperatively at a first and a second follow-up. The minimal detectable change, Student t test, Fisher exact test, and nonasymptotic chi-square analysis with an alpha of p < 0.05 were used to determine significance. Results: The no-tourniquet group had more calculated blood loss (1,148.02 mL compared with 966.64 mL; p < 0.001) and more difficulty with surgical field visualization (p < 0.0001). The tourniquet group had greater knee extension at the first follow-up (−7° compared with −9°; p = 0.044). Conclusions: Tourniquet use during TKA significantly decreases blood loss and does not adversely affect early postoperative outcomes. Tourniquet use during routine TKA is safe and effective, and concerns about deleterious effects on function and pain may not be justified. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Short-term outcomes of total knee arthroplasty performed with and without a tourniquet

“…Functional results similar to ours have been reported by Goel et al and McCarthy et al who showed that there is no differences in pain, ROM and quadriceps function at any point during the in-hospital period between tourniquet and tourniquet-less surgery [9,20]. By contrast, Huang et al reported that tourniquet use was associated with lower ROM and higher pain up until the 5th postoperative day [21].…”

“…There is conflicting evidence regarding pain, functional outcome, blood loss from heterogeneous samples of tourniquet use [3][4][5][6][7][8]. Advocates of tourniquet use cite better visualisation of the surgical field, better cement interdigitation, and overall less blood loss [9][10][11]. Conversely, tourniquet use might relate to increased pain, limb ischaemia, delayed range of motion (ROM) and quadriceps function recovery, accelerated quadriceps sarcopenia in the elderly, more thromboembolic events, increased length of stay (LOS), and a higher hospital readmission rate [7,[12][13][14].…”

Utilization of epinephrine-soaked gauzes to address bleeding from osteotomy sites in non-tourniquet total knee arthroplasty: a retrospective cohort study

“…The primary outcomes of the study were surgical field visualization including surgeon-rated difficulty in visualization and number of surgical field clearances [17,18]. Surgeon-rated difficulty in visualization prior to using epinephrine in Epinephrine group and before cementing in two groups, was graded (Grading scale for difficulty of intraoperative visualization due to blood: 0 No Difficulty; 1 Some difficulty, but did not affect the case; 2 Moderate difficulty; 3 Severe difficulty), and independently assessed by two senior authors (Z. L. and W. G.) at the end of the surgery; Number of surgical field clearances (excluding action of using epinephrine-soaked gauzes) was counted by another author (H. L.) in two groups over the period from the finish of bone cutting through the cement hardening.…”

Comparing Sequential vs Simultaneous Tourniquet Inflation in Bilateral Total Knee Arthroplasty

“…Tourniquet use in TKA is common and has been demonstrated to decrease intraoperative blood loss and allow for increased surgical field visualization [8,9]. When compared to TKA where no tourniquet is used, current literature has shown functional and pain outcomes to be similar [8,10].…”

“…Tourniquet use in TKA is common and has been demonstrated to decrease intraoperative blood loss and allow for increased surgical field visualization [8,9]. When compared to TKA where no tourniquet is used, current literature has shown functional and pain outcomes to be similar [8,10]. Dennis et al [11] echoed these findings in a randomized prospective trial, adding that there is an early (<3 months) quadriceps strength advantage in tourniquetless TKA with unknown clinical significance.…”