Primary total knee arthroplasty with or without the use of tourniquet

Abstract

Introduction Total knee arthroplasty (TKA) may be the only effective treatment available to reduce pain and restore joint mobility and function in case of advanced osteoarthritis of the knee. The major benefit of TKA with the use of tourniquet is operating in a bloodless field. A possible secondary benefit is a better cement bone interface for fixation. However, the use of tourniquet in TKA is associated with multiple risk factors both local and systemic. The aim of this work To compare between the use or nonuse of tourniquet on patients operated for TKA. Patients and methods This study included 30 TKA in 30 patients. The comparison was made between 15 TKA done with the use of tourniquet in 15 patients (group A) and 15 TKA done without the use of tourniquet in the next consecutive 15 patients (group B). Full preoperative assessment including clinical, laboratorial, and radiological examination with routine investigations was done for every patient. The intraoperative blood loss and the need for and amount of blood transfusion were estimated. Immediate postoperative assessment included the estimation of hemoglobin level, blood loss, and need for and amount of blood transfusion. The 3-month postoperative evaluation included the pain by visual analog scale, range of knee flexion, and time to straight leg raising. Results There was no major operative complication during the procedures. Intraoperative blood loss was higher in group B (1273.3±430.1 ml), and postoperative blood loss was higher in group A (623.3±161.0 ml). Overall, 60% of group B patients had increased need for blood transfusion. Moreover, 26.7% of patients in group A compared with 6.7% of patients in group B had severe postoperative pain on the visual analog scale. The mean time to straight leg raising was 6.67±1.18 weeks in group A and 4.73±0.70 weeks in group B. The mean range of knee flexion was 118.33±5.56° in group A and 124.80±3.91° in group B after 3 months. Conclusion TKA done without the use of tourniquet is accompanied by more intraoperative blood loss and increased need for both intraoperative and postoperative blood transfusion. TKA without the use of tourniquet accelerates the recovery of knee flexion range and shortens the time for straight leg raising.