A Tourniquet Versus Non-Tourniquet Method in Total Knee Arthroplasty: A Single Center Study in Aden
Introduction: Tourniquet use in surgery of lower limb was a standard method in orthopaedic, mainly in total knee replacement arthroplasty (TKA), and the avoidance of a tourniquet still a matter of concern and debate among orthopaedic surgeons. This study was conducted to compare the results of using tourniquet versus non-tourniquet method during total knee replacement operation done in a private hospital in Aden Governorate.
Methods: A prospective comparative study included 49 patients underwent TKA in a private hospital in Aden during 2018-2020. They were randomized 1:1 to the use of tourniquet (group I, n=23) or non-tourniquet (group II, n=26). In group I, the tourniquet cuff pressure was inflated based on the patients’ systolic pressure and a margin of 100 mm Hg (generally the pressure was ≤ 225 mmHg). The cuff was inflated immediately before surgery and deflated as soon as surgery ended. The primary outcome was the blood requirements after surgery. Secondary outcomes were pain, quadriceps extension strength and range of motion.
Results: The median age was 57 years in group I and 60 years in group II. The female to male ratio was 2.3:1 in group I and 1.8:1 in group II. Bleeding during operation was statistically significantly higher among group II (mean: 575± 91.9 ml); compared with 276±83.7ml in group I. Post-operatively, bleeding was statistically significantly higher among group I (767±101.8 ml); compared to 198±107.2 ml in group II. Post-operatively, three patients from group I needed transfusion of 1 unit packed red blood cells and no patient from group II needed blood transfusion. Pain was mild in all group II patients and in 60.9% of group I patients with significant statistical difference (p<0.05). The quadriceps extension strength (QES) was not significantly affected in 88.5% of group II, while 73.9% of group I showed mild to moderate weakness. The range of motion was significantly full range in 88.5% of group II patients while mild limitation was observed among 69.6% of group I patients.
Conclusion: This study concluded that in spite of the higher intra-operative blood loss, performing TKA without tourniquet is superior to the use of tourniquet in terms of post-operative outcome.
Keywords: Tourniquet, TKA, Bleeding, Pain, QES, Range of motion.