Faster recovery without the use of a tourniquet in total knee arthroplasty

Abstract

Background and purpose: Tourniquet application is still a common practice in total knee arthroplasty (TKA) surgery despite being associated with several adverse effects. We evaluated the effects of tourniquet use on functional and clinical outcome and on knee range of motion (ROM).

Patients and methods: 70 patients who underwent TKA were randomized into a tourniquet group (n = 35) and a non-tourniquet group (n = 35). All operations were performed by the same surgeon and follow-up was for 1 year. Primary outcomes were functional and clinical outcomes, as evaluated by KOOS and knee ROM. Secondary outcomes were intraoperative blood loss, surgical time and visibility, postoperative pain, analgesic consumption, and transfusion requirements.

Results: Patients in the non-tourniquet group showed a better outcome in all KOOS subscores and better early knee ROM from surgery to week 8. No difference was detected at the 6- and 12-month follow-ups. Postoperative pain and analgesic consumption were less when a tourniquet was not used. Surgical time and visibility were similar between groups. Intraoperative blood loss was greater when not using a tourniquet, but no postoperative transfusions were required.

Interpretation: This study shows that TKA without the use of a tourniquet results in faster recovery in terms of better functional outcome and improved knee ROM. Furthermore, reduced pain and analgesic use were registered and no intraoperative difficulties were encountered.

Figure 1.

Flow diagram of the participants.

Figure 2.

Mean values for KOOS subscales at baseline and through follow-up as an outcome profile for the tourniquet group vs. the non-tourniquet group. KOOS subscales: pain, symptoms, activity in daily living (ADL), sport and recreation (Sport/Rec), and quality of life (QOL). Early improvement was detected in all KOOS subscales at 8 weeks in the non-tourniquet group.Statistical significance is shown with the symbol ^a.

Figure 3.

Range of motion. Better knee ROM was seen postoperatively and at the 8 week follow-up when a tourniquet had not been used. Statistical significance is shown with the symbol ^a.