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The effects of tourniquet use in total knee arthroplasty: a randomized, controlled trial

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Tourniquets are still widely used in total knee arthroplasty (TKA), although they may be associated with several adverse effects. An observer-blinded, randomized, controlled trial was performed to evaluate the effects of tourniquet use in TKA.

Methods

Fifty participants who underwent staged bilateral TKA were recruited for this study. The first-side TKA was randomly allocated to either long-duration tourniquet use or short-duration tourniquet use followed by a 3-month washout period and crossover to the other tourniquet strategy for the opposite-side TKA. Blood loss was monitored perioperatively. The operating time, allogeneic blood transfusion rate, thigh pain, knee pain, limb swelling, clinical outcome as measured by the Likert-type Western Ontario and McMaster University (WOMAC) score, straight leg raising and knee active range of motion (ROM) were also recorded.

Results

The long-duration tourniquet group exhibited reduced total blood loss [−99.1 ml, 95 % confidence interval (CI) −168.1 to −30.1, P = 0.0411] and intraoperative blood loss (−225.2 ml, 95 % CI −369.5 to −80.9, P = 0.0071) compared with the short-duration tourniquet group. However, there were greater postoperative blood loss (69.6 ml, 95 % CI 21.1 to 118.2, P = 0.0282) and hidden blood loss (52.8 ml, 95 % CI 10.5 to 95.1, P = 0.0332) in the long-duration tourniquet group. The short-duration tourniquet group showed better outcomes for thigh and knee pain, limb swelling, WOMAC score at 6-week follow-up, straight leg raising and knee ROM. Similar allogeneic blood transfusion rates were observed for both groups.

Conclusion

Total and intraoperative blood losses were reduced with the long-duration tourniquet use, whereas the short-duration tourniquet use would reduce postoperative and hidden blood losses without increasing the allogeneic blood transfusion rate. In addition, short-duration tourniquet use would result in faster recovery and less pain during the early rehabilitation period following TKA.

Level of evidence

I.

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Acknowledgments

We acknowledge Guangshan Sui MS, Ke Yuan MS, and Jiebing Li MS for their assistance with inpatient testing; Bin Wang Ph.D., for assistance with study coordination, including the randomization of participants and the statistical analysis; and Yuankun Xu Ph.D., for assistance with labVIEW programming. This study was supported by Peking University People’s Hospital Research and Development Funds (Project No. RDC2013-06). Zhichang Li MD was in charge of this Hospital Fund programme and made a contribution similar to the first author.

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Authors and Affiliations

  1. Arthritis Clinic and Research Center, Peking University People’s Hospital, Peking University, Xizhimen South Street No. 11, Beijing, China

    Kai Wang, Songjia Ni, Zhichang Li, Qunjie Zhong, Rujun Li, Hu Li, Yan Ke & Jianhao Lin

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  1. Kai Wang
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  2. Songjia Ni
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  3. Zhichang Li
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  8. Jianhao Lin
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Correspondence to Jianhao Lin.

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Wang, K., Ni, S., Li, Z. et al. The effects of tourniquet use in total knee arthroplasty: a randomized, controlled trial. Knee Surg Sports Traumatol Arthrosc 25, 2849–2857 (2017). https://doi.org/10.1007/s00167-015-3964-2

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  • DOI: https://doi.org/10.1007/s00167-015-3964-2

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