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

Abstract

Background:Total knee arthroplasty (TKA) is usually performed successfully with or without a tourniquet and under spinal anesthesia (SA) or general anesthesia (GA). However, 10% to 34% of patients experience dissatisfaction and pain after TKA. We aimed to compare the effects of tourniquet use and SA or GA on TKA outcomes.Methods:We randomly assigned 404 patients to 4 study groups: SA without a tourniquet (NT/SA), SA with a tourniquet (T/SA), GA without a tourniquet (NT/GA), and GA with a tourniquet (T/GA). The primary outcome was the change in the Oxford Knee Score (OKS) at 1 year postoperatively. Secondary outcomes included a satisfactory TKA outcome assessed using the OKS minimal important change (MIC) and OKS patient acceptable symptom state (PASS), adverse events, and quality of life using the 15-dimensional health-related quality of life tool.Results:At 1 year, the OKS was obtained for 381 patients. In the 2-group comparisons, the tourniquet did not affect the OKS improvement. The SA group had more substantial improvement in the OKS than the GA group (16.21 compared with 14.08 a mean difference of 2.13; 95% confidence interval [CI], 0.55 to 3.71; p = 0.008). In the 4-group comparisons, the T/SA group had more substantial improvements in the OKS than the NT/GA group (16.87 compared with 13.65, a mean difference of 3.2; 95% CI, 0.28 to 6.17; p = 0.026). The SA group reached the OKS MIC more frequently than the GA group (91.7% compared with 81.7%; odds ratio [OR] = 2.49 [95% CI, 1.32 to 4.69]; p = 0.005). The SA group also reached the OKS PASS more frequently than the GA group (86.0% compared with 75.7%; OR = 2.00 [95% CI, 1.18 to 3.39]; p = 0.010). The T/SA group had significantly more patients reaching the OKS MIC than the NT/GA group (95.7% compared with 79.6%; p = 0.005) and more patients reaching the OKS PASS than the NT/GA group (92.6% compared with 74.5%; p = 0.004). No differences were seen with respect to adverse events in any comparisons.Conclusions:The tourniquet had no detrimental effects on the outcomes of TKA. SA had a positive effect on the OKS. The use of SA combined with a tourniquet resulted in the best improvement in OKS and the highest proportion of satisfactory outcomes with TKA.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

HURWA robotic-assisted total knee arthroplasty improves component positioning and alignment – A prospective randomized and multicenter study

“…Traditional TKA depends on surgical instruments to complete knee joint parameter measurement, prosthesis model selection and surgical scheme implementation. Although new prosthesis and surgical instruments with more perfect design are constantly coming out, and the surgical technology of the operator is also improving year by year, TKA has not yet become a perfect operation, and its postoperative dissatisfaction rate is as high as 20% [ 39 , 40 ]. The main cause is that TKA has high requirements on the position of prosthesis placement, reconstruction of lower limb force line and maintenance of postoperative stability, while manual operation is difficult to ensure the accuracy and consistency of surgical operation [ [41] , [42] , [43] ].…”

Postoperative pain as a risk factor for stiff knee following total knee arthroplasty and excellent patientreported outcomes after manipulation under anesthesia

“…We conducted a retrospective comparative analyses with regard to MUA for 391 patients who had undergone fast-track TKA in a randomized trial comparing the use of a tourniquet and two anesthesia methods (spinal or general) with a 1-year follow-up ( 12 , 13 ).…”

Fat tissue is a poor predictor of 1 year outcomes after total knee arthroplasty: A secondary analysis of a randomized clinical trial

“…A detailed study description and results concerning the anesthesia and tourniquet comparisons have been published. 26–29…”

“…A detailed study description and results concerning the anesthesia and tourniquet comparisons have been published. [26][27][28][29] Patients referred for TKA due to Kellgren-Lawrence grade 3 to 4 osteoarthritis, aged 18-75 years, and with a BMI of ⩽40 kg/m 2 were eligible for the trial. Patients who had undergone prior major surgery, such as osteotomy, or had a severe valgus or varus malalignment (>15°), or flexion or extension deficit (maximum flexion of <90° or flexion contracture of >20°) of the study knee were excluded.…”