Effect of Tourniquet Application on Postoperative Functional Outcome Following Total Knee Arthroplasty: A Prospective Cohort Study

Abstract

Background: A pneumatic tourniquet is often used during total knee arthroplasty (TKA). However, tourniquet application is often associated with an increased incidence of adverse events and soft tissue damage due to high mechanical pressure. This could potentially result in delayed recovery. The aim of the present study was to evaluate the effect of tourniquet use during TKA on the postoperative functional outcome. Methods: In this prospective cohort study, patients were eligible for inclusion when they were scheduled for primary TKA due to osteoarthritis, age between 50 and 75 years and Dutch language proficiency. Exclusion criteria were inflammatory arthritis, severe cardiac complaints, severe pulmonary disorders, Body Mass Index (BMI) >35, severe coagulation disorders or hospitalization in the previous two months before surgery. The Knee Osteoarthritis Outcome Score (KOOS) questionnaire was obtained at baseline and eight weeks postoperative to evaluate the functional outcome. In addition, muscle strength of the upper and lower limb, range of motion (ROM) of the knee joint and Visual Analogue Scale (VAS) were assessed as secondary outcomes. Length of stay, analgesic consumption and adverse events were also recorded. Results: In total, 96 consecutive patients undergoing TKA met the inclusion criteria. They received usual care according to the surgeon’s preferences whereas 49 patients received no tourniquet (non-tourniquet group) during surgery and in 47 patients a tourniquet was standard applied (tourniquet group). There were no significant differences between both groups in terms of KOOS 1) pain (p=0.398), 2) symptoms (p=0.514), 3) daily living (p=0.904), 4) sport/ recreation (p=0.635) and 5) knee-related quality of life (p=0.970) scores eight weeks after surgery. Also no significant differences were found in respect to knee ROM (p=0.982) and muscle strength (p=≤0.300) during follow-up. We found however, less pain in the tourniquet group compared to the non-tourniquet group but this was only significant during the first days after surgery (p=≤0.043). Conclusion: Our results show that tourniquet application during TKA did not significantly affect the short-term functional outcome as assessed by KOOS scores, ROM of the knee joint and muscle strength of the upper and lower limb. However, there were minor differences in respect to knee related pain between both groups during the first days after surgery.