The use of tourniquet in total knee arthroplasty does not impact the functional outcome: a randomised controlled study
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Background
This study evaluates the clinical evidence for performing total knee arthroplasty (TKA) without a tourniquet, a shift from the near-universal use in 2009 to current trends towards tourniquet-less TKA in Norway and Sweden. This change is set against a backdrop of conflicting evidence regarding the positive and negative effects of tourniquet use.
Questions/purposes
The aims were to determine if the tourniquet has an impact on [1] Forgotten Joint Score-12 (FJS-12) at 8 weeks after surgery; [2] postoperative strength and function; [3] postoperative pain and opioid analgesic use; and [4] operative time, bleeding, and length of stay (LOS).
Methods
Eighty-one patients were randomised to TKA with or without a tourniquet. The outcome measures, FJS-12, muscle strength, functional test, pain, estimated blood loss, haemoglobin (Hb) loss, knee circumference, opioid consumption, and LOS were assessed preoperatively and at 1 day, 8 weeks, and 1 year after surgery.
Results
No significant difference in FJS-12 scores was found between the two groups at postoperative 8 weeks. However, the tourniquet group showed statistically significant better knee extension strength at 8 weeks ( p = 0.045). There were no differences in other outcomes, except for a greater decrease in haemoglobin levels ( p = 0.02) and higher estimated perioperative blood loss ( p < 0.001) in the no tourniquet group than the torniquet group.
Conclusions
Our study indicates that tourniquet use during TKA causes no significant differences in FJS-12 at 8 weeks, significantly reduces bleeding and postoperative Hb loss, and improves quadriceps strength at 8 weeks.
Trial registration
Clinicaltrails.gov. Registry Number: NCT03666598. Registered 30 August 2018.
