Effects of Tourniquet Use on Blood Loss and Soft-Tissue Damage in Total Knee Arthroplasty: A Randomized Controlled Trial

• Published in: Journal of bone and joint surgery. American volume 2012-12, Vol.94 (24), p.2209-2215
• Main Authors: Tai, Ta-Wei, Chang, Chih-Wei, Lai, Kuo-An, Lin, Chii-Jeng, Yang, Chyun-Yu
• Format: Article
• Language: English
• Subjects: Aged; Arthroplasty, Replacement, Knee; Biological and medical sciences; Biomarkers - blood; Blood Loss, Surgical - prevention & control; Diseases of the osteoarticular system; Female; Hematocrit; Hemoglobins - analysis; Hemostasis, Surgical - methods; Humans; Linear Models; Male; Medical sciences; Orthopedic surgery; Soft Tissue Injuries - prevention & control; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tourniquets; Treatment Outcome
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.K.00813

BACKGROUND:Although tourniquets are widely used in total knee arthroplasty, their effectiveness in reducing blood loss and their influence on the postoperative course remain unclear. Tourniquet-related soft-tissue damage is a related concern. We performed a prospective, randomized, controlled trial to clarify the effect of tourniquets in total knee arthroplasty. METHODS:Seventy-two patients undergoing total knee arthroplasty were randomly allocated to a tourniquet or non-tourniquet group. Blood loss and changes in C-reactive protein, creatine phosphokinase, and other indicators of soft-tissue damage were monitored preoperatively and postoperatively on Days 1, 2, and 4. Thigh pain, knee pain, limb swelling, rehabilitation progress, and hospital stays were also recorded for comparison. RESULTS:Patients in the tourniquet group showed smaller decreases in hemoglobin (mean and standard deviation, 2.6 ± 0.9 versus 3.7 ± 1.3 g/dL) and hematocrit (7.6% ± 2.8% versus 10.4% ± 4.0%), less calculated blood loss (303 ± 119 versus 423 ± 197 mL), and smaller increases in C-reactive protein (peak value, 175 ± 55 versus 139 ± 75 mg/dL) and creatine phosphokinase (peak value, 214 ± 89 versus 162 ± 104 U/L) compared with those in the non-tourniquet group. There was slightly less postoperative pain in the non-tourniquet group. There were no significant differences between the groups in terms of swelling, rehabilitation progress, or hospital stays. CONCLUSIONS:The use of a tourniquet during total knee arthroplasty was effective for reducing blood loss and avoiding excessive postoperative inflammation and muscle damage. The use of a tourniquet was related to slightly more postoperative pain but did not affect postoperative recovery. LEVEL OF EVIDENCE:Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.