Effect of tourniquet use on blood loss and postoperative function in total knee arthroplasty

Abstract

INTRODUCTION: The effectiveness of tourniquet in total knee arthroplasty in reducing blood loss and their influence on the postoperative course remain unclear. We performed a prospective randomised controlled trial to clarify its effect. METHODS: A total of 24 patients undergoing total knee arthroplasty were randomly allocated to 3 groups regarding the application of tourniquet: from skin to cement hardening, only during cementation, and from skin to skin. Postoperative lower limb mechanical axis and individual component position were measured on radiographs. Blood loss and changes in serological indicators of soft tissue damage were monitored perioperatively. Thigh pain, knee pain, limb swelling, and rehabilitation progress were also recorded. RESULTS: The mean (± standard deviation) age of the patients was 72 ± 7.5 years. There was no difference in terms of patients’ preoperative demographic data between 3 groups. The mean tourniquet time in 3 groups was 34 ± 6.6, 8.5 ± 0.7 and 65.8 ± 25.8 minutes, respectively (p=0.014). There was no significant difference in intra-operative blood loss, drain output, change in haemoglobin and haematocrit, thigh and knee pain, thigh and leg swelling, change in C-reactive protein, and lactate dehydrogenase level between 3 groups. The only difference was found in postoperative increase in creatine kinase on day 1 and day 2. There was also no difference in terms of the lower limb mechanical axis and position of individual components on postoperative radiographs. CONCLUSION: Early results did not show any significant difference in majority of the parameters between different tourniquet application methods.