Abstract
Introduction
Tourniquets have been used for many years during total knee arthroplasty as a means of achieving a bloodless field for better visualization and cement-bond inter-digitation. Controversy has surrounded the necessity for a tourniquet in past years. There are many advantages and disadvantages to using a tourniquet, and one prominent disadvantage is a purported increase in post-operative pain and limitations in range of motion.
Objective
This study examined the literature for assessment of pain and analgesia usage in post-operative patient who have either received no tourniquet during surgery or received variations in both timing and pressure. Secondary outcomes included were functional in nature, namely range of motion and post-operative hospital stay.
Methods
Three hundred and nineteen articles were searched and narrowed to 6 using the QUORUM approach. All were randomized, controlled trials with specific exclusion criteria.
Results
When analyzing each trial, pain did not seem to be significantly lower in those with no tourniquet. Instead, patients who received lower pressures for only a portion of the surgery had lower pain levels. Range of motion was consistently higher in the non-tourniquet groups compared to the tourniquet patients in all studies that included this measure. There was no difference in hospital stay within the groups for each trial.
Conclusion
Our conclusion is that this question is not as straightforward as originally perceived. Patients who receive tourniquet compression up until cementation at lower cuff pressures using a wider cuff may be at an advantage in their post-operatively outcomes.
