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.
Copyright © 2015 Elsevier B.V. All rights reserved.