The use of tourniquet in primary total knee arthroplasty – a randomized controlled trial

Abstract

Introduction: We performed a prospective randomised controlled trial to investigate the effectiveness of tourniquet in total knee arthroplasty (TKA) in reducing blood loss and their influence on the postoperative course. Methods: A total of 90 patients undergoing unilateral TKA by a single surgeon were randomly allocated to 3 groups regarding the application of tourniquet: from skin to cement hardening, only during cementation, and from skin to skin. 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 age of the patients was 74.7 ± 6.8 years. There was no difference in terms of patients’ preoperative demographic data between the 3 groups. Significant differences were found in the mean tourniquet time, intra-operative blood loss, and total drain output (p<0.05). There was no significant difference in the change in haemoglobin and haematocrit, thigh and knee pain, thigh and leg swelling, creatine kinase, CRP, and LDH between the 3 groups. There was also no difference in terms of the lower limb mechanical axis and individual components position on postoperative radiographs. In terms of early complication, there was 1 case of transient common peroneal nerve palsy in skin-to-cement group and 1 case of transient deranged liver function in skin-to-skin group. All rehabilitation parameters and clinical scores showed no difference up to 6 months postoperatively. Conclusion: Our results did not show any significant difference in majority of the parameters between different tourniquet application methods.