The effects of tourniquet use in total knee arthroplasty: a randomized, controlled trial

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 25; no. 9; pp. 2849 - 2857
• Main Authors: Wang, Kai, Ni, Songjia, Li, Zhichang, Zhong, Qunjie, Li, Rujun, Li, Hu, Ke, Yan, Lin, Jianhao
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2017; Springer Nature B.V
• Subjects: Aged; Arthroplasty (knee); Arthroplasty, Replacement, Knee - methods; Biomedical materials; Blood Loss, Surgical; Blood Transfusion; Blood transfusions; Confidence intervals; Edema - etiology; Female; Humans; Joint surgery; Knee; Leg; Male; Medicine; Medicine & Public Health; Ontario; Operative Time; Orthopedics; Outcome Assessment (Health Care) - methods; Pain; Postoperative Hemorrhage - etiology; Postoperative Period; Randomization; Range of Motion, Articular; Rehabilitation; Side effects; Surgical implants; Swelling; Thigh; Time Factors; Tourniquets; Tourniquets - adverse effects; Transfusion; Tourniquet; Clinical outcome; Total knee arthroplasty; Blood loss
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-015-3964-2

Purpose Tourniquets are still widely used in total knee arthroplasty (TKA), although they may be associated with several adverse effects. An observer-blinded, randomized, controlled trial was performed to evaluate the effects of tourniquet use in TKA. Methods Fifty participants who underwent staged bilateral TKA were recruited for this study. The first-side TKA was randomly allocated to either long-duration tourniquet use or short-duration tourniquet use followed by a 3-month washout period and crossover to the other tourniquet strategy for the opposite-side TKA. Blood loss was monitored perioperatively. The operating time, allogeneic blood transfusion rate, thigh pain, knee pain, limb swelling, clinical outcome as measured by the Likert-type Western Ontario and McMaster University (WOMAC) score, straight leg raising and knee active range of motion (ROM) were also recorded. Results The long-duration tourniquet group exhibited reduced total blood loss [−99.1 ml, 95 % confidence interval (CI) −168.1 to −30.1, P  = 0.0411] and intraoperative blood loss (−225.2 ml, 95 % CI −369.5 to −80.9, P  = 0.0071) compared with the short-duration tourniquet group. However, there were greater postoperative blood loss (69.6 ml, 95 % CI 21.1 to 118.2, P  = 0.0282) and hidden blood loss (52.8 ml, 95 % CI 10.5 to 95.1, P  = 0.0332) in the long-duration tourniquet group. The short-duration tourniquet group showed better outcomes for thigh and knee pain, limb swelling, WOMAC score at 6-week follow-up, straight leg raising and knee ROM. Similar allogeneic blood transfusion rates were observed for both groups. Conclusion Total and intraoperative blood losses were reduced with the long-duration tourniquet use, whereas the short-duration tourniquet use would reduce postoperative and hidden blood losses without increasing the allogeneic blood transfusion rate. In addition, short-duration tourniquet use would result in faster recovery and less pain during the early rehabilitation period following TKA. Level of evidence I.