Abstract
Introduction
Total knee arthroplasty (TKA) is associated with significant blood loss, for which blood transfusion might be necessary. The role of the tourniquet is controversial, though it is widely used by orthopedic surgeons. Its use was believed to be effective in decreasing intraoperative blood loss and creating a bloodless surgical field, which theoretically would facilitate the cementing technique and other surgical procedures. However, reactive blood flow reached its peak within five minutes after the tourniquet had been released. The tourniquet controls intraoperative blood loss, but cannot stop postoperative blood loss. Patients who were managed with a tourniquet during the operation often complained of thigh pain. This was possibly caused by the direct pressure of an inflated tourniquet on the nerves and local soft tissues. Limb swelling and increased soft tissue tension caused by reactive hyperperfusion after tourniquet deflation may also contribute to the wound pain. The aim of our study is to investigate the effect of tourniquet on blood loss and soft tissue damage in TKA.
Materials & Methods
In this prospective, randomized study, 72 patients with primary cemented knee arthroplasty were randomly allocated to two groups (with and without tourniquet). The operation time, blood loss, post-operative hemoglobin, hematocrit, markers of soft tissue damage (myoglobin, Cretine Posphokinase(CK), LDH, GOT, Creatinine), status of rehabilitation, knee pain and thigh pain were monitored until discharge.
Results
The intra-operative and total blood loss is more in non-tourniquet. The post-operative levels of hemoglobin and hematocrit were significant higher in tourniquet group until postoperative day 4. Using tourniquet also shortened the operation time. Patients managed without tourniquet showed higher CK level in postoperative day 2. The severity of knee pain was similar in both group. Mild thigh pain was noted in tourniquet group.
Conclusions
Our randomized controlled trial revealed that the usage od tourniquet in TKA may save blood and save time with minor adverse effect. Without using tourniquet, the prolonged surgical time and excessive hemostasis may cause more soft tissue damage.
