No effect of tourniquet in primary total knee arthroplasty on muscle strength, functional outcome, patient satisfaction and health status: a randomized clinical trial

Jawhar, Ahmed; Skeirek, Dania; Stetzelberger, Vera M.; Kollowa, Karl; Obertacke, U.

doi:10.1007/s00167-019-05646-5

Cited by 24 publications

(35 citation statements)

References 39 publications

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“…Although various randomized clinical trials have been published, the use of a tourniquet during total knee joint replacement has still been a topic of debate [15][16][17]. There is conflicting evidence regarding the effect of tourniquet use on perioperative blood loss and postoperative function and pain.…”

Section: Discussionmentioning

confidence: 99%

Application of Tourniquet Does Not Influence Early Clinical Outcomes After Total Knee Arthroplasty

Chaudhry¹,

Aziz²,

Faraz³

et al. 2021

Cureus

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Introduction The use of a tourniquet during total knee arthroplasty (TKA) is still a topic of debate, given the conflicting results in the literature with respect to complications, pain, functional outcome, and blood loss. However, due to a lack of convincing data on early patient-reported outcomes (PROMS), this study aims to compare pain and functional outcomes in total knee arthroplasty patients with and without a tourniquet. Methods A randomized controlled trial was set up at a tertiary care hospital that spanned from 1 st February 2015 to 31 st July 2018. We included all primary total knee arthroplasties performed for patients aged between 50 and 80 years. Oxford Knee Score (OKS), Numerical Pain Rating Score (NPRS), Visual Analogue Scale (VAS) for satisfaction, active range of knee motion, and Short Form-12 Survey (SF-12) scores were collected pre-surgery and then at six-weeks and six-months interval with a p-value of 0.05 considered to be significant. Results Two hundred and forty patients participated in the study; 117 patients were randomized to surgery with the tourniquet inflated and 123 to surgery with the tourniquet deflated. There were 43.4% males, and 56.6% females in the tourniquet inflated group with an average age of 62.29±9.63 years while in tourniquet deflated group, there were 46.7% males and 53.3% females with a mean age of 65.41±9.042 years (p-value for age is 0.404; the p-value for gender is 0.086). Despite the increase in intraoperative blood loss in both the groups, there was no significant increase in blood transfusions as both groups recorded the need for postoperative blood transfusion - 12 patients in the tourniquet group and 19 in the non-tourniquet group, but this difference was statistically insignificant (p=0.231). The perioperative blood loss was significantly lower (p<0.001) in the tourniquet group (490.29±47.752) compared to in the non-tourniquet group (526.18±12.796), while the duration of surgery was comparable in both groups (p=0.156). The length of stay for the two groups did not statistically differ (p=0.976) - the mean length of stay for the tourniquet group was 6.16±2.38 days and for the non-tourniquet group it was 6.18±2.34 days. There were no significant differences between the two groups regarding patient-reported outcomes (PROMS) at six-weeks and six-months. However, during the in-hospital stay, only the NPRS score for knee pain showed that the non-tourniquet patients had a lower NPRS compared to the tourniquet group and this difference was statistically significant (p=0.02). During the postoperative hospital stay, there was no significant difference among the two treatment groups for VAS, OKS, SF-12, and range of motion (flexion/extension). At the six weeks follow-up, both groups had similar outcomes for the range of movements and pain scores. Besides, no difference was noted among the tourniquet and non-tourniquet gro...

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Section: Discussionmentioning

confidence: 99%

Application of Tourniquet Does Not Influence Early Clinical Outcomes After Total Knee Arthroplasty

Chaudhry¹,

Aziz²,

Faraz³

et al. 2021

Cureus

View full text Add to dashboard Cite

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“…Jahwar et al have recently shown in a prospective study no difference in functional outcome using or not a tourniquet for primary TKA (16) even with a high pressure of 360 mm Hg. Recovery after TKA is certainly more influenced by all perioperative measures than by the use or not of the tourniquet.…”

Section: Discussionmentioning

confidence: 93%

“…The inflate tourniquet-pressure is directly correlated to the rate of complications (5). It is therefore logical to suppose that decreasing the tourniquet-inflate pressure would decrease these complications, however very few papers have demonstrated this (16,17). Interestingly, lower tourniquet-inflate pressures used nowadays are certainly one of the reasons why recent studies show very different results from previous ones concerning TKA complications.…”

Section: Table Imentioning

confidence: 99%

Lower total blood loss in total knee arthroplasty with a low-pressure tourniquet than without

Joufflineau¹,

Thienpont²

2021

Acta Orthop Belg

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Tourniquet-use has been described in litera- ture as a surgical factor leading to increased post-operative hidden blood loss in total knee arthroplasty (TKA). The hypothesis for this retro- spective study was that low-pressure tourniquet TKA would offer the benefits of tourniquet surgery without the potential negative effects on late blood loss after the procedure. Therefore, this study evaluated total (TBL) and hidden blood loss (HBL) in TKA with or without a tourniquet. We retrospectively compared two groups : one group (n= 54) undergoing TKA without a tourniquet and one group with a low-pressure tourniquet (n= 110). The outcomes compared were hemoglobin levels 2 weeks before surgery and at days 2 and 4 after surgery to calculate total and hidden blood loss, transfusion rate, and functional outcome. A higher total blood loss was observed in the no tourniquet group with a mean loss of 1073 mL against 890 mL in the tourniquet group (p-value = 0,003). Hidden blood loss values between both groups were statistically not significant : in the no-tourniquet group, Hb drop between D2 and D4 was 0.5 g/dL against 0.4 g/ dL in the low-pressure tourniquet group. The tourniquet-less group did not present with better functional scores. This study showed that low- pressure tourniquet use reduces TBL without increasing HBL in TKA.

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“…Regarding perioperative blood loss, Jawhar et al also reported reduced intraoperative bleeding with the use of a tourniquet but no difference in total bleeding volume [ 16 ]. They also subsequently reported no difference in functional outcomes and patient-reported outcomes in the same cohort [ 19 ]. However, Hasanain et al reported that the use of a tourniquet reduced total bleeding without postoperative complications [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Safety of Total Knee Arthroplasty without Using a Tourniquet in Elderly Patients

Miyamoto¹,

Kosugi²,

Sasaki³

et al. 2021

Geriatrics

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This study retrospectively compared the perioperative bleeding, hemodynamics, and clinical outcomes of total knee arthroplasty (TKA) performed with and without a tourniquet between two age groups. We grouped 103 patients with knee osteoarthritis who underwent primary TKA based on age at surgery: <76 years and ≥76 years. Tourniquet was used for TKA until March 2010 and stopped thereafter; hence, the patients were further classified according to TKA performed with or without a tourniquet. The differences in the operation time; perioperative bleeding; estimated bleeding; and hemoglobin (Hb) and hematocrit (Ht) levels immediately, 1 day, and 7 days postoperatively were evaluated. The clinical outcomes for range of motion, and Knee Society Knee Scores preoperatively and at 4 weeks postoperatively were assessed. Operation time was longer in the ≥76-year-old non-tourniquet group. No difference was observed in estimated bleeding among the groups. Changes in the Hb and Ht levels at postoperative days 1 and 7 were negatively correlated with age but were not different for TKA performed with or without a tourniquet in the ≥76-year-old-patient group. There were no differences in clinical outcomes among the groups. TKA can be performed with or without a tourniquet in patients aged ≥ 76 years with careful assessment of postoperative anemia.

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No effect of tourniquet in primary total knee arthroplasty on muscle strength, functional outcome, patient satisfaction and health status: a randomized clinical trial

Cited by 24 publications

References 39 publications

Application of Tourniquet Does Not Influence Early Clinical Outcomes After Total Knee Arthroplasty

Application of Tourniquet Does Not Influence Early Clinical Outcomes After Total Knee Arthroplasty

Lower total blood loss in total knee arthroplasty with a low-pressure tourniquet than without

Safety of Total Knee Arthroplasty without Using a Tourniquet in Elderly Patients

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