Summary

Inflating tourniquet prior to skin incision during TKA does not significantly affect postoperative pain, range of motions, or quality of life but does reduce intraoperative blood loss when compared to inflating only during cement and implants insertion.

Abstract

Introduction

The use of a tourniquet during total knee arthroplasty (TKA) is a common practice to control intraoperative bleeding. However, its application may lead to complications such as skin blisters, wound hematoma, muscle damage, and deep vein thrombosis (DVT), which can delay postoperative recovery and rehabilitation. This study aims to evaluate the impact of tourniquet timing on postoperative knee joint function, pain, and quality of life in patients undergoing TKA, to provide a reference for healthcare providers.

Methods

Following ethical approval, a double-blinded prospective randomized clinical trial was conducted on patients undergoing TKA. Participants were randomly assigned to one of two groups: the experimental group (tourniquet inflated only during cement and implants insertion) and the control group (tourniquet inflated prior to skin incision). All surgeries were performed by the same surgeon, with a follow-up period of two months. Primary outcomes included pain scores, knee joint function (range of motion and knee circumference), patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score (KOOS), and the 36-item Short Form Health Survey (SF-36)). Secondary outcomes included intraoperative blood loss, operative time, intraoperative fluid infusion volume, and length of hospital stay.

Results

From July 2023 to July 2024, 66 patients met the inclusion criteria and participated in the study in a regional hospital in Taipei. There were 34 patients in the experimental group and 32 patients in the control group, with a majority being female (84.8%), an average BMI of 27.11 ± 3.98 kg/m², and an average age of 77.5 ± 7.6 years. Statistical analysis showed no significant differences in demographic variables between the groups. There were no significant differences between the groups in terms of hospital stay, total operative time, or intraoperative fluid infusion volume. However, intraoperative blood loss was significantly higher in the experimental group (104.1 ± 120.0 mL) compared to the control group (25.9 ± 36.3 mL, p < 0.001 ). There were no statistically significant differences in pain scores, knee joint function and patient-reported outcomes between the two groups at various postoperative time points.

Conclusion

This study suggests that inflating tourniquet prior to skin incision during TKA does not significantly affect postoperative pain, range of motions, or quality of life but does reduce intraoperative blood loss when compared to inflating only during cement and implants insertion. Further research with larger sample sizes and longer follow-up periods is recommended to validate these findings.