Abstract
PurposeWhen a tourniquet is used during surgery on the extremities, the pressure applied to the muscles, nerves and blood vessels can cause neuromuscular damage that contributes to postoperative weakness. The hypothesis was that the rehabilitation-related results would be improved if total knee arthroplasty (TKA) is performed without the use of a tourniquet.Methods81 patients with osteoarthritis of the knee who underwent TKA surgery were randomized to surgery with or without tourniquet. Active flexion and extension of the knee, pain by visual analog scale (VAS), swelling by knee circumference, quadriceps function by straight leg raise, and timed up and go (TUG) test results were measured before and up to 3 months after surgery.ResultsANCOVA revealed no between-groups effect for flexion of the knee at day 3 postsurgery. Compared with the tourniquet group, the nontourniquet group experienced elevated pain at 24 h, with a mean difference of 16.6 mm, p = 0.005. The effect on mobility (TUG test) at 3 months was better in the nontourniquet group, with a mean difference of -1.1 s, p = 0.029.ConclusionsThe hypothesis that the rehabilitation-related results would be improved without a tourniquet is not supported by the results. When the results in this study for surgery performed with and without tourniquet are compared, no clear benefit for either procedure was observed, as the more pain exhibited by the nontourniquet group was only evident for a short period and the improved mobility in this group was not at a clinically relevant level.Level of evidenceInconsistent results, Level II.
Highlights
In 2011, 12,048 primary total knee arthroplasties (TKAs) were performed in Sweden, and a tourniquet was used in approximately 90% of them [1]
Depending on the occlusion time and the magnitude of the applied pressure, tourniquet use has been associated with an increased risk of neuromuscular damage, which contributes to postoperative weakness of the quadriceps that can persist for weeks, months, and even approximately a year [2,3,4,5,6,7,8]
There was no difference between the nontourniquet group and tourniquet groups regarding additional analgesia consumption at day 1 (28% vs. 24% [n.s])
Summary
In 2011, 12,048 primary total knee arthroplasties (TKAs) were performed in Sweden, and a tourniquet was used in approximately 90% of them [1]. Several other studies have demonstrated that knee flexion within the first week after TKA is better when a tourniquet. In 5 studies, the effect on straight leg raise (SLR) was reported to be better in the first days after TKA when either no tourniquet was used or was used for only a short period [10, 13, 17,18,19]. A metaanalysis provided evidence of the positive effect on knee flexion when surgery was performed without a tourniquet [9]. The effects on knee flexion and SLR were similar for surgery with and without the use of a tourniquet [20]. The effects on knee flexion were similar for surgery with longand short duration of tourniquet use [21]
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