43.
Value of tourniquet in TKA surgery
Ashir Ejaz, Mogens, B Laursen, Andreas Kappel, Poul T. Nielsen, Sten
Rasmussen
Ortopædkirurgisk afd. Aalborg Sygehus; Ortopædkirurgisk afd., Aalborg
Sygehus; Ortopædkirurgisk afd., Aalborg Sygehus; Ortopædkirurgisk afd.,
Aalborg Sygehus; Ortopædkirurgisk afd., Aalborg Sygehus
Background:
The pneumatic tourniquet is widely used during TKA. Use of
the tourniquet is associated with increased risk of complications, specifically
DVT/PE, nerve palsy, tourniquet compartment syndrome. Other common
harmful effects are thigh swelling and pain. All these affect postoperative
recovery.
Purpose / Aim of Study:
To evaluate benefits and disadvantages of tourniquet
use during TKA surgery by quantifying effects such as postoperative pain,
swelling and knee range of motion.
Materials and Methods:
A prospective RCT with 70 consecutive patients
aged 50-85 (mean= 68) underwent primary unilateral TKA. All operations
were performed in spinal anesthesia and by the same surgeon. Patients were
randomly allocated to one of two groups: operation with tourniquet (Group A)
and operation without tourniquet (Group B). The operative procedure, cuff
pressure and postoperative pain treatment was standardized. All patients were
evaluated at day 1, 2, and 3 and on outpatient basis in 8th week and 6th month.
Pain was assessed by VAS and analgesia requirement. Thigh swelling was
measured as circumference and ROM was registered goniometric. Furthermore
all patients filled out questionnaires ED-Q5, KOOS and OKS.
Findings / Results:
Using a tourniquet during TKA did increase postoperative
pain significantly on day 1,2 and 3 at discharge and on the 8th postoperative
week, also a trend for better ROM. Thigh swelling was increased significantly
in group A, by day 3 and by week 8 there was no difference. Throughout first
8
weeks Group B main complaint was thigh pain and slower mobilisation.
Results will be presented.
Conclusions:
We have determined that performing TKA without tourniquet is
safe, beneficial and provides faster recovery for patients. We suggest not using
tourniquet in TKA surgery, to avoid potential adverse effect of tourniquet.
