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J Knee Surg 2023; 36(02): 222-230
DOI: 10.1055/s-0041-1731719
Original Article

Effects of the Use of Tourniquet in Total Knee Arthroplasty on the Clinical and Functional Outcomes with 5 Years of Follow-up: A Randomized Controlled Trial

Sherwan A. Hamawandi 
1   Department of Orthopedic, College of Medicine, Hawler Medical University, Erbil, Iraq
,
Hazhar I. Amin
2   Department of Orthopaedics, Erbil Teaching Hospital, Erbil, Iraq
,
Ameer K. Al-Humairi
3   Department of Community Medicine, College of Medicine, University of Babylon, Hilla, Iraq
› Author Affiliations Funding None.
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Abstract

The use of tourniquet in total knee arthroplasty (TKA) had a lot of controversies with no clear agreement about the advantages and disadvantages of tourniquet. This study aims to show the effects of tourniquet use in TKA on the functional and clinical outcomes with follow-up of 5 years. This is a randomized, double-blind, and single-center study of 101 patients who were treated by TKA and divided randomly into two groups. Tourniquet was used in group A and was not used in group B. Both groups were assessed by Knee Society score (KSS), knee injury and osteoarthritis outcome score (KOOS), visual analogue scale (VAS) score for thigh pain, and postoperative complications. Both groups were followed up for 5 years. The group of no tourniquet showed significant better functional outcomes measured by KSS at postoperative periods of 2 weeks (p = 0.001), 6 weeks (p = 0.006), and 3 months (p = 0.034), and KOOS at postoperative periods of 2 weeks (p = 0.001), 6 weeks (p =0.001), and 3 months (p = 0.016). However, there was no significant difference in long-term follow-up of 5 years. There were significantly better results with use of tourniquet regarding surgeon's visualization during surgery, less operative time, and less calculated blood loss, while significantly better results with no use of tourniquet were reported regarding less hospital stay, less postoperative analgesic consumption, and less postoperative thigh pain measured by VAS score at postoperative periods of day 1 (p = 0.001), day 5 (p = 0.001), 2 weeks (p = 0.001), and 6 weeks (p = 0.001). Regarding postoperative blood transfusion and clinical deep venous thrombosis, there was no significant difference between use of tourniquet or not. The evidence presented in this level-1 randomized controlled trial suggests that no use of tourniquet in TKA can improve functional outcomes in early postoperative period with no significant difference on functional outcome at 5 years of follow-up.

Keywords

total knee arthroplasty - tourniquet - functional outcomes

Note

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.




Publication History

Received: 04 August 2020

Accepted: 31 May 2021

Article published online:
14 July 2021

© 2021. Thieme. All rights reserved.

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