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J Bone Joint Surg Am. 2012 Dec 19;94(24):2209-15. doi: 10.2106/JBJS.K.00813.

Effects of tourniquet use on blood loss and soft-tissue damage in total knee arthroplasty: a randomized controlled trial.

Author information

1
Department of Orthopaedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 183 Sheng-Li Road, 704, Tainan, Taiwan. david0803@gmail.com

Abstract

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.

PMID:
23318610
DOI:
10.2106/JBJS.K.00813
[Indexed for MEDLINE]
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