Tourniquetless Total Knee Arthroplasty With Modern Perioperative Protocols Decreases Pain and Opioid Consumption in Women

J Arthroplasty. 2018 Nov;33(11):3455-3459. doi: 10.1016/j.arth.2018.06.038. Epub 2018 Jul 5.


Background: This study examined whether a modern total knee arthroplasty (TKA) protocol without a tourniquet results in less patient-reported pain and in-hospital opioid consumption compared to TKA with a tourniquet.

Methods: A retrospective study of 203 primary unilateral cemented TKAs consecutively performed with or without tourniquet was performed. Identical perioperative pain and blood loss protocols were used in all cases. In tourniquetless TKAs, the tourniquet was not inflated at any time, and sterile CO2 gas compression maximized cement interdigitation.

Results: After exclusions for scientific confounds, 184 TKAs (93 with tourniquet; 91 tourniquetless) were analyzed. Controlling for multiple covariates, females with a tourniquet reported significantly more pain (P = .002) and opioid consumption (P < .001) the first 24 hours after surgery compared to females without a tourniquet. There were no differences in pain (P = .192) or amount of opioids consumed (P = .203) among males with and without a tourniquet. Tourniquet use resulted in a significant reduction in blood loss for both females (P ≤ .040) and males (P ≤ .020), although the total blood savings of approximately 200 mL is of unknown clinical significance.

Conclusion: Avoiding tourniquet use during TKA for females may be a relatively risk-free adjunct to minimize opioid consumption during hospitalization. Further study is warranted to elucidate the factors accounting for different outcomes in females and males.

Keywords: blood loss; opioids; pain; total knee arthroplasty; tourniquet; tourniquetless.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesics, Opioid / administration & dosage*
  • Arthroplasty, Replacement, Knee / adverse effects
  • Arthroplasty, Replacement, Knee / methods*
  • Blood Loss, Surgical / prevention & control
  • Blood Loss, Surgical / statistics & numerical data
  • Bone Cements
  • Female
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Pain, Postoperative / drug therapy
  • Pain, Postoperative / etiology*
  • Retrospective Studies
  • Tourniquets / adverse effects*


  • Analgesics, Opioid
  • Bone Cements