Tourniquet versus no tourniquet on knee-extension strength early after fast-track total knee arthroplasty; a randomized controlled trial

Abstract

Tourniquet versus no tourniquet on knee-extension strength early after fast-track total knee arthroplasty; a randomized controlled trial.Harsten, Andreas; Bandholm, Thomas; Kehlet, Henrik; Toksvig-Larsen, Sören Link to publication Citation for published version (APA): Harsten, A., Bandholm, T., Kehlet, H., & Toksvig-Larsen, S. (2015). Tourniquet versus no tourniquet on kneeextension strength early after fast-track total knee arthroplasty; a randomized controlled trial. Knee, 22(2), 126-130. DOI: 10.1016/j.knee.2014 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal TKA= total knee arthroplasty, CNS= central nervous system, ASA = American Society of Anesthesiologists, PACU= post anaesthesia care unit, LOS = length of hospital stay Declaration of interestNone declared FundingThe study was supported with institutional grants.Trial registry number: NCT01808859. The study was approved by the Research Ethics Committee at Lund University (no 2012/11) and was carried out at Hässleholm Hospital, Sweden.TKA= total knee arthroplasty, CNS= central nervous system, ASA = American Society of Anesthesiologists, PACU= post anaesthesia care unit, LOS = length of hospital stay AbstractBackground. Thigh tourniquet is commonly used in total knee arthroplasty (TKA) but may contribute to pain and muscle damage. Consequently, the reduction in knee-extension strength after TKA may be caused by quadriceps muscle ischaemia underneath the cuff.Aim. To examine if not using a thigh tourniquet during surgery was more effective than using a thigh tourniquet in preserving knee-extension strength 48hours after fast-track TKA. Methods.A total of 64 patients undergoing TKA were randomized (1:1) to the use of tourniquet (T-group) or no tourniquet (NT-group). In the T-group the tourniquet cuff pressure was based on the patient's systolic pressure and a margin of 100 mm Hg. It was inflated immediately before surgery and deflated as soon as surgery ended. The primary outcome was the change in kneeextension strength from pre-surgery to 48 hours after surgery (primary end point). Secondary outcomes were pain, nausea, length of hospital stay (LOS) and periarticular swelling.Results. Knee-extension strength 48 hours after surgery was substantially reduced by about 90% in both groups, with no statistically significant difference between groups (mean difference 1.5 N/kg, 95% CI 1.3-1.6). Among the secondary outcomes, the T-group had less bleeding during surgery (56 vs 182 mL, P < 0.01) compared with the NT-g...

A small difference in recovery between total knee arthroplasty with and without tourniquet use the first 3 months after surgery: a randomized controlled study

“…However, the results of the latter study are difficult to interpret because of possible under-powering and because the patients were not blinded [31]. Other studies have reported a better effect on either ROM [15] or 2 or more rehabilitation-related outcome measures, including ROM, pain, SLR, swelling, and ADL function, when a tourniquet is either not used or is used for only a short period [10–14, 16–19].…”

Influence of fast-track programs on patient-reported outcomes in total hip and knee replacement (THR/TKR) at Swedish hospitals 2011–2015: an observational study including 51,169 THR and 8,393 TKR operations

“…In the fast-track cohort of TKR the use of a tourniquet was less common, but the influence of a tourniquet on functional outcome is inconclusive according to previous studies (Ledin et al 2012, Zhang et al 2014, Harsten et al 2015, Zhou et al 2017. Ledin et al (2012) showed in a small randomized study an improved range of motion (ROM) persisting after 2 years and Harsten et al (2015) showed no effect regarding postoperative pain and muscle strength when a tourniquet was not used while Zhang et al (2014) and Zhou et al (2017) found a better ROM in early stage after surgery when not using a tourniquet.…”

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

“…It has been suggested that long-term use of tourniquet can reduce intraoperative and intraoperative total blood loss, while short-term use of tourniquet can reduce postoperative and postoperative hidden blood loss without increasing the rate of allogeneic blood transfusion [23]. Interestingly, some studies found that 48 h after total knee arthroplasty, the strength of knee extension was not superior in the group without tourniquet, but tourniquet caused lower limb pain [24,25]; others suggested that the use of tourniquet had no signi cant correlation with postoperative rehabilitation [26]. In summary, studies on tourniquet use or not have been reported, but there is little literature comparing postoperative rehabilitation with limited tourniquet use versus no tourniquet use.…”