Absence of a tourniquet does not affect quality of cementation in TKA : A concise radiological review at a minimum of 2 years

Abstract

Introduction: Application of tourniquet in total knee arthroplasty is postulated to improve cement penetration, but its effect is not proven. Tourniquet also affect rehabilitation due to muscle inflammation and pain. We aim to evaluate the effect of tourniquet on cement penetration and long-term functional outcome. We hypothesize that the effect is insignificant. Methodology: This is a case-controlled study involving patients who underwent TKA between 2014-2017 in a public hospital. Patients were divided into tourniquet and non-tourniquet group. Surgeon, surgical technique and implant types are controlled. X-ray measurements of cementation depth and presence of radiolucent lines were recorded. Pre and post-operative functional scores KSKS and KSFA were compared. Analysis of covariance (ANCOVA) was used for statistical analysis. Results and Analysis: 76 patients were included. X-Ray measurements of cement depth showed no significant difference between the two groups at day 1 and 2-years (p=0.219-0.668). There was no significant difference in the presence of RLL (p=0.187-0.868). There was however better KSKS (93.12+-3.73 vs 89.97, P=0.014) and KSFA (76.80+-20.46 vs 62.07+-13.40, P=0.005) in the tourniquet group. Discussion and Conclusion: There is no benefit of tourniquet usage on cementation in TKA. Tourniquet group had better functional outcome, which may be accountable to better pre-op parameters such as range of motion in the tourniquet group. A better study design is needed for conclusive evidence.