INTRODUCTION: Total knee arthroplasty (TKA) is commonly performed using tourniquet despite being associated with several recognised complications that may affect patient's post-operative recovery and early rehabilitation. In this study we investigate whether or not use of a tourniquet during TKA was associated with shorter length of stay, faster recovery and lesser complications. METHODS: 29 patients, who underwent bilateral sequential TKA, had their first TKA under tourniquet and the second TKA 15 (11-32) months later without tourniquet.All operations were performed by the first author using the same technique and instrumentation with the same early rehabilitation protocol. All patients were followed prospectively for a minimum of 8 months.All patients had the following parameters measured which included surgical time, length of stay, post-operative pain using Visual analogue score (VAS), calf circumference, drop in haemoglobin, haematocrit level, oxford knee score (OKS), and range of motion (ROM). RESULTS: TKA performed without the use of tourniquet had significantly shorter Length of hospital stay (3.6 vs 4.4, P < 0.05), significantly less pain on day 2 (1 vs 2; P < 0.05) and significantly smaller increase in calf circumference on day 2 (1.2 cm vs 2.3 cm; P < 0.05). Postoperative calf circumference increase of less than 2 cm in TKA without tourniquet was associated with shorter length of stay when compared with increase of more than 2 cm in TKA with tourniquet 2.9 days (SD 0.6) versus 3.9 days (SD 0.8) P < 0.05.ROM and OKS were significantly better in TKA without tourniquet at 6 weeks but no difference at 8 months. CONCLUSIONS: TKA done without tourniquet was associated with shorter length of stay, lesser pain and swelling, in addition to improved range of motion in the early post-operative period.
INTRODUCTION: Total knee arthroplasty (TKA) is commonly performed using tourniquet despite being associated with several recognised complications that may affect patient's post-operative recovery and early rehabilitation. In this study we investigate whether or not use of a tourniquet during TKA was associated with shorter length of stay, faster recovery and lesser complications. METHODS: 29 patients, who underwent bilateral sequential TKA, had their first TKA under tourniquet and the second TKA 15 (11-32) months later without tourniquet.All operations were performed by the first author using the same technique and instrumentation with the same early rehabilitation protocol. All patients were followed prospectively for a minimum of 8 months.All patients had the following parameters measured which included surgical time, length of stay, post-operative pain using Visual analogue score (VAS), calf circumference, drop in haemoglobin, haematocrit level, oxford knee score (OKS), and range of motion (ROM). RESULTS: TKA performed without the use of tourniquet had significantly shorter Length of hospital stay (3.6 vs 4.4, P < 0.05), significantly less pain on day 2 (1 vs 2; P < 0.05) and significantly smaller increase in calf circumference on day 2 (1.2 cm vs 2.3 cm; P < 0.05). Postoperative calf circumference increase of less than 2 cm in TKA without tourniquet was associated with shorter length of stay when compared with increase of more than 2 cm in TKA with tourniquet 2.9 days (SD 0.6) versus 3.9 days (SD 0.8) P < 0.05.ROM and OKS were significantly better in TKA without tourniquet at 6 weeks but no difference at 8 months. CONCLUSIONS: TKA done without tourniquet was associated with shorter length of stay, lesser pain and swelling, in addition to improved range of motion in the early post-operative period.
Authors: Alexander Tsarouhas; Michael E Hantes; Georgios Tsougias; Zoe Dailiana; Konstantinos N Malizos Journal: Arthroscopy Date: 2012-10-22 Impact factor: 4.772
Authors: Stephen G Zak; Nishanth Muthusamy; Chelsea Sicat; James Slover; Ran Schwarzkopf Journal: Indian J Orthop Date: 2022-08-04 Impact factor: 1.033
Authors: Imran Ahmed; Amit Chawla; Martin Underwood; Andrew J Price; Andrew Metcalfe; Charles Hutchinson; Jane Warwick; Kate Seers; Helen Parsons; Peter Dh Wall Journal: Cochrane Database Syst Rev Date: 2020-12-08