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
