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Knee. 2015 Mar;22(2):126-30. doi: 10.1016/j.knee.2014.12.010. Epub 2014 Dec 31.

Tourniquet versus no tourniquet on knee-extension strength early after fast-track total knee arthroplasty; a randomized controlled trial.

Author information

1
Dept of Anesthesiology, Hässleholm Hospital and Lund University, Box 351, 281 25 Hässleholm, Sweden. Electronic address: andreas.harsten@skane.se.
2
Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Dept of Physical Therapy, Denmark; Dept of Orthopedic Surgery, Hvidovre Hospital, University of Copenhagen, Denmark; Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Denmark.
3
Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Denmark; Dept of Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Blegdamsvej 9, DK-2100, Denmark.
4
Dept of Orthopedic Surgery, Hässleholm Hospital and Lund University, Box 351, 281 25 Hässleholm, Sweden.

Abstract

BACKGROUND:

Thigh tourniquet is commonly used in total knee arthroplasty (TKA) but may contribute to pain and muscle damage. Consequently, the reduction in knee-extension strength after TKA may be caused by quadriceps muscle ischaemia underneath the cuff.

AIM:

To examine if not using a thigh tourniquet during surgery was more effective than using a thigh tourniquet in preserving knee-extension strength 48 h after fast-track TKA.

METHODS:

A total of 64 patients undergoing TKA were randomized (1:1) to the use of tourniquet (T-group) or no tourniquet (NT-group). In the T-group the tourniquet cuff pressure was based on the patient's systolic pressure and a margin of 100 mm Hg. It was inflated immediately before surgery and deflated as soon as surgery ended. The primary outcome was the change in knee-extension strength from pre-surgery to 48 h after surgery (primary end point). Secondary outcomes were pain, nausea, length of hospital stay (LOS) and periarticular swelling.

RESULTS:

Knee-extension strength 48 h after surgery was substantially reduced by about 90% in both groups, with no statistically significant difference between groups (mean difference 1.5 N/kg, 95% CI 1.3-1.6). Among the secondary outcomes, the T-group had less bleeding during surgery (56 vs. 182 mL, P<0.01) compared with the NT-group. There was no difference in postoperative haemoglobin levels, pain, nausea, LOS or periarticular swelling between the groups.

CONCLUSION:

Not using a thigh tourniquet during surgery was not superior in preserving knee-extension strength at the primary endpoint 48 h after fast-track TKA, compared to using a tourniquet.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01808859.

KEYWORDS:

Complication; Quadriceps muscle function; Total knee arthroplasty; Tourniquet

PMID:
25648580
DOI:
10.1016/j.knee.2014.12.010
[Indexed for MEDLINE]

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