Abstract
Recent changes in perioperative management of total knee patients including tranexamic
acid, multimodal pain management, and periarticular injection make previous data on
tourniquet use during total knee arthroplasty (TKA) less relevant. The purpose of
this study was to evaluate the effect of tourniquet use on short-term postoperative
outcomes in the era of modern TKA. Our institutional database was utilized to retrospectively
identify three cohorts (long, short, and no tourniquet) of consecutive patients after
unilateral TKA with a single surgeon. These three groups were compared using analysis
of variance (ANOVA) and post hoc Tukey's tests. Primary endpoints being hemoglobin
index (difference in preoperative and postoperative hemoglobin), inpatient narcotic
use, surgical time, length of hospital stay (total hours and % day1 discharges), and
distance ambulated prior to discharge. The no-tourniquet group used significantly
less narcotic than the short-tourniquet (2.4 vs. 2.9 morphine equivalent/hour, p = 0.004) and long-tourniquet groups (2.4 vs. 3.4 morphine equivalents/hour, p < 0.001). The no-tourniquet group ambulated significantly further than patients in
the short (108 vs. 57 feet, p < 0.001) and long (108 vs. 76 feet, p < 0.001) groups. Finally, the no-tourniquet group had significantly shorter duration
of hospitalization than the long-tourniquet group in both hours in the hospital (35
vs. 57 hours, p < 0.001) and % postoperative day 1 discharge (57 vs. 12%, p < 0.001). TKA without the use of a tourniquet is associated with less narcotic consumption
and increased distance ambulated prior to discharge compared with cohorts of patients
utilizing tourniquet for a short or long duration.
Keywords
primary total knee arthroplasty - tourniquet - opiates - pain
