Tourniquet use in the first half-course of total knee arthroplasty does not affect postoperative functional outcomes or pain: a prospective, randomized controlled trial

doi:10.12307/2021.191

Abstract

Abstract: BACKGROUND: Tourniquets use in total knee arthroplasty was highly controversial.
OBJECTIVE: To optimize operative program in total knee arthroplasty by making a comparison on rehabilitation of postoperative patients between two strategies: front half (released after the prosthesis was placed) or no tourniquet use.
METHODS: Two hundred patients with unilateral knee osteoarthritis were randomized to undergo total knee arthroplasty either with a tourniquet use in the first half-course (first half-course tourniquet group, 100 patients) or no tourniquet use (no tourniquet group, 100 patients). Primary outcome measures were functional assessment testing using the Timed Up & Go test and Visual Analogue Scale, Knee Injury and Osteoarthritis Outcome Score, and 12-Item Short Form Health Survey scores. Secondary outcome measures included the stair-climb test, blood loss, operation time, surgical field visualization, and range of motion. Outcome measures were completed preoperatively, in the hospital, and postoperatively at a first (4 and 5 weeks postoperatively) and a second follow-up (6 and 7 months postoperatively).
RESULTS AND CONCLUSION: (1) Postoperative knee joint function of both groups improved significantly compared with those before surgery (P < 0.05). (2) The incidence rate of thigh numbness of front-half tourniquet use group was higher during hospitalization (P < 0.05). However, average perioperative blood loss was less (P < 0.001) and visualized surgical field was wider (P < 0.001). (3) At first follow-up, knee joint extension degree was bigger (P=0.03) and the mean Knee Injury and Osteoarthritis Outcome Score associated with living quality were both higher in front-half tourniquet use group than those of no tourniquet use group (P=0.03). (4) At the second follow-up, although patients in the non-tourniquet use group climbed stairs faster, there was no statistical significance between the two groups (P=0.08). Other assessment results also presented no statistical difference between these two groups. (5) It is concluded that in spite of high incidence rate of thigh numbness which may not cause adverse effects, first half-course tourniquet use in total knee arthroplasty reduces blood loss and provides wider surgical field visualized. This strategy in total knee arthroplasty was safe and effective and can also advance the application of rapid recovery mode.

Key words: knee, osteoarthritis, total knee arthroplasty, prosthesis, tourniquet, enhanced recovery

CLC Number:

Hu Shouye, Yang Zhi, Hao Yangquan, Lu Chao, Zhang Qiong, Zhang Weisong, Zhu Yujie, Peng Kan. Tourniquet use in the first half-course of total knee arthroplasty does not affect postoperative functional outcomes or pain: a prospective, randomized controlled trial[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(27): 4327-4332.

Figures/Tables 8

References

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