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Knee Surg Relat Res. 2014 Dec;26(4):207-13. doi: 10.5792/ksrr.2014.26.4.207. Epub 2014 Dec 2.

Effects of tourniquet use on quadriceps function and pain in total knee arthroplasty.

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Gold Coast Centre for Bone and Joint Surgery, John Flynn Private Hospital, Gold Coast, Australia.
Department of Orthopedic Surgery, Gold Coast and Robina Hospitals, Gold Coast, Australia.
Clinical Data Solutions, Sydney, Australia.
University of Sydney, Kolling Institute, Murray Maxwell Biomechanics Laboratory, Royal North Shore Hospital, Sydney, Australia.



A pneumatic tourniquet is commonly used in total knee arthroplasty (TKA) to improve surgical field visualisation but may result in quadriceps muscle ischaemia. We performed this study to analyse the effect of the tourniquet on recovery following TKA.


A prospective randomised single-blinded trial was undertaken to examine the effect of the tourniquet on post-operative pain, swelling, blood loss, quadriceps function and outcome following TKA. Twenty patients with osteoarthritis of the knee were randomised to tourniquet or no tourniquet groups. Quadriceps function was assessed using surface electromyography (EMG) during active knee extension.


The no tourniquet group had significantly less pain in the early post-operative period compared to the tourniquet group. There was no difference in Oxford knee score, range of motion, or thigh and knee swelling up to 12 months post-operatively. Quadriceps function, measured by surface EMG, was compromised for the first six months post-surgery by tourniquet use. The radiological cement mantle at the bone prosthesis interface at 12-month follow-up was not affected by the absence of a tourniquet.


We believe that it is safe and beneficial for our patients to routinely perform TKA without a tourniquet.


Arthroplasty; Knee; Pain; Quadriceps; Tourniquet

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