Optimizing Tourniquet Pressure in Primary Total Knee Arthroplasty: Limb Occlusion Pressure vs Systolic Blood Pressure Method: A Randomised Controlled Study.

Abstract

This study aims to systematically compare the efficacy of two distinct approaches that is limb occlusion pressure (LOP) and systolic blood pressure (SBP) in determining the optimal tourniquet pressure for primary total knee arthroplasty. The overarching goal is to identify the method that yields superior outcomes in minimizing post-operative thigh pain while simultaneously reducing complications in our patient population. 311 patients scheduled for primary total knee replacement (TKR) were randomized in two groups. Group A (LOP) had 154 patients and group B had 157 patients. In group A, LOP was determined for all patients. After adding the safety margin, the tourniquet pressure was determined which was kept during the procedure. By adding 150mm Hg to SBP in group B, the tourniquet inflation pressure was ascertained. Postoperatively, thigh pain was evaluated from day 1 to day 3 and at 6weeks. The average tourniquet pressure in group A patients having thigh circumference between 40 and 50cm was 223.8mm + -19.8mm Hg and in group B it was 262.1 + -15.9mm Hg (P < .01). Patients having thigh circumference between 51 and 60cm had average tourniquet pressure of 240.07 + -20.1mm Hg in group A and 264.5 + -17.4mm Hg in group B (P < .01). The average tourniquet pressure for patients with thigh circumference more than 60cm was 296 + /15.3mm Hg in group A and 267.3 + /19.2mm Hg in group B (P < 0.01). Tourniquet pressure determination based on the limb occlusion pressure (LOP) method provide less postoperative thigh pain and better range of motion. Optimizing Tourniquet Pressure in Primary Total Knee Replacement: Limb Occlusion Pressure vs Systolic blood pressure method to minimize thigh pain.