Much ado about nothing: the effect of tourniquet time on an accelerated rehabilitation programme following total knee replacement (TKR).

Abstract

The WHO includes osteoarthritis as a disease of priority, owing to its significant impact on quality of life, and globally increasing prevalence. Hospital budgets are under pressure to ration knee replacements and shorten inpatient stays. Prolonged tourniquet application has been hypothesised to extend recovery through pain and reduced mobility. A total of 123 elective total knee replacements meeting inclusion criteriatook place from July 2015 to October 2017 at the Royal Free Hospital. Cases were standardised by method of TKR, implant, physiotherapy and analgesic regime according to the trust Enhanced Recovery after Surgery pathway. Tourniquet time was compared to length-of-stay post-operatively and total opioid analgesia requirement over 24h. Median tourniquet time overall was 74min and was decreased year-on-year from 108 to 60min (p = 0.000). Inpatient median length-of-stay was 5days and did not decrease (p = 0.667). Increased tourniquet time was not associated with longer length-of-stay but in fact shorter (p = 0.03199), likely due to this confounding temporal trend. Increased tourniquet time was not associated with increased opioid requirement (p = 0.78591). No association was found between tourniquet time and other complications including DVT and infection. Our study finds no evidence that reductions in tourniquet time in TKR improve recovery including length-of-stay or opioid requirement. This clinical data is expected to augment PROMs collected by the National Joint Registry.