Tourniquet use during total knee arthroplasty does not modulate the neutrophil-to-lymphocyte ratio, pain, or activity

Abstract

The purpose of our study was to identify the influence of tourniquet use during total knee arthroplasty (TKA) on the neutrophil-to-lymphocyte ratio (NLR) shortly after surgery and patient-reported outcomes (pain and physical activity) from outpatient physical therapy. This retrospective study consisted of 104 subjects who underwent primary unilateral TKA (51 subjects with and 53 subjects without tourniquet assistance) between 2010 and 2012. The NLR was calculated from the absolute neutrophil and lymphocyte counts obtained immediately before and after (1 and 2 days) knee arthroplasty. The Knee Outcome Survey (KOS) of Activities of Daily Living and numeric pain scores collected at the first [33.0 (34.2) days after surgery] and last [85.5 (40.7) days after surgery] outpatient physical therapy visits were extracted from an electronic database. The NLR, pain, and KOS score were not significantly (all p > 0.05) different with tourniquet use. Based on these findings, we conclude that tourniquet use during TKA neither increases systemic inflammation shortly after surgery nor impairs patient-reported outcomes obtained during outpatient physical therapy.Level of evidenceIV.

The effect of limited versus no tourniquet use on rapid recovery in total knee replacement--a randomized controlled trial

“…The application of tourniquet in total knee arthroplasty can effectively reduce intraoperative bleeding, provide a clean and clear surgical eld, and also facilitate the application of bone cement technology [6], but its postoperative complications such as early postoperative pain, lower limb swelling, and tension blisters make its use value controversial [7,8]. As the concept of enhanced recovery was put forward [9][10][11], more and more scholars proposed the restrictive use of tourniquets as well as the optimal use of tourniquets [12][13][14] There are a wide variety of studies on tourniquets, such as the timing of tourniquet release [15,16], the location of tourniquet installation and the pressure of tourniquet [17], and the timely and long tim ing of tourniquet use [18], and most scholars agree that the length of tourniquet use has a signi cant correlation with postoperative complications: Barker, T et al [19] concluded that the use of tourniquets for more than 100 min in total knee arthroplasty will increase the risk of postoperative wound infection, deep vein thrombosis, pulmonary embolism, and nerve injury. Jawhar et al [20] found that surgery longer than 120 min with a tourniquet increased the risk of deep ve in thrombosis.…”

Use of a Tourniquet and Spinal Anesthesia Increases Satisfactory Outcomes After Total Knee Arthroplasty

“…However, several studies have found that TKA without a tourniquet decreases pain, LOS, and complications; increases the range of motion of the knee; and has no effect on cementing quality 18,21-27 . High-quality information about the impact of tourniquet use on patient satisfaction remains unclear 22,28-32 .…”

“…and complications; increases the range of motion of the knee; and has no effect on cementing quality 18,[21][22][23][24][25][26][27] . High-quality information about the impact of tourniquet use on patient satisfaction remains unclear 22,[28][29][30][31][32] .…”