Summary
The use of a tourniquet during knee arthroplasty reduces intraoperative blood loss but does not affect postoperative anemia or total blood loss, and may even be associated with increased hidden blood loss and higher early postoperative CPK levels, suggesting the need for careful consideration of tourniquet use and its potential complications.
Abstract
Introduction
Knee arthroplasty is an effective treatment for end-stage osteoarthritis of the knee. Intraoperative blood loss during bone cutting and soft tissue release has been a challenge for orthopedic surgeons. Currently, tourniquets are widely used to control intraoperative bleeding and ensure a clear surgical field. However, there are reports suggesting that the use of tourniquets during knee arthroplasty may have adverse effects, such as increased pain, leg swelling, impaired knee function, limited range of motion, and prolonged hospitalization. Thus, the usefulness of tourniquet use in knee arthroplasty remains controversial. In this study, we evaluated the effects of tourniquet use on postoperative hemoglobin (Hb) levels, creatine phosphokinase (CPK) levels, intraoperative blood loss, total blood loss (TBL), and hidden blood loss (HBL) in knee arthroplasty cases performed at our department.
Methods
We retrospectively evaluated 121 knees that underwent knee arthroplasty in our department between 2022 and 2024 (male/female: 84/37, mean age: 74.2±8.7 years). Preoperative, postoperative day 1, and postoperative week 1 Hb and CPK levels, as well as intraoperative blood loss, were compared between cases with tourniquet use (T(+) group, n=98) and those without (T(-) group, n=24). TBL and HBL were calculated up to postoperative day 1 using the Gross equation, and compared between the two groups. Statistical analysis was performed using the t-test, with
Significance
level set at P<0.05.
Results
Intraoperative blood loss was significantly lower in the T(+) group compared to the T(-) group (T(-) 253.3±166.6mL, T(+) 83.3±84.0mL, P<0.001). However, there was no significant difference in Hb levels between the two groups on postoperative day 1 or week 1 (D1: T(-) 11.46±1.33g/dL, T(+) 11.58±1.51g/dL, P=0.70; D7: T(-) 11.26±1.38g/dL, T(+) 11.26±1.63g/dL, P=1.00). Additionally, there was no significant difference in TBL or HBL between the two groups on postoperative day 1 (TBL D1: T(-) 496.7±295.1mL, T(+) 383.7±267.8mL, P=0.089; HBL D1: T(-) 247.2±279.1mL, T(+) 301.1±63.4mL, P=0.40), although there was a trend toward lower volume of HBL in the T(-) group. CPK levels on postoperative day 1 were significantly higher in the T(+) group (T(-) 133.9±74.4 U/L, T(+) 197.9±112.0 U/L, P=0.0014), howoever, no significant difference was observed between the groups at postoperative week 1 (T(-) 58.0±34.1 U/L, T(+) 73.5±49.4 U/L, P=0.077).
Discussion
This study demonstrated that while the use of a tourniquet reduces intraoperative blood loss, there was no significant difference in postoperative anemia or total blood loss after surgery compared to the condition without tourniquet. Moreover, there was a tendency for lower HBL in the non-tourniquet group, suggesting that postoperative blood loss may increase with tourniquet use. The use of a tourniquet should take into account not only complications including muscle damage, postoperative pain, and intraoperative blood loss, but also postoperative haemorrhage, and should be used with appropriate haemostasis.