TY - JOUR

T1 - Tourniquet versus no tourniquet on knee-extension strength early after fast-track total knee arthroplasty; a randomized controlled trial

AU - Harsten, Andreas

AU - Bandholm, Thomas Quaade

AU - Kehlet, Henrik

AU - Toksvig-Larsen, Sören

N1 - Copyright © 2015 Elsevier B.V. All rights reserved.

PY - 2015/3

Y1 - 2015/3

N2 - BACKGROUND: Thigh tourniquet is commonly used in total knee arthroplasty (TKA) but may contribute to pain and muscle damage. Consequently, the reduction in knee-extension strength after TKA may be caused by quadriceps muscle ischaemia underneath the cuff.AIM: To examine if not using a thigh tourniquet during surgery was more effective than using a thigh tourniquet in preserving knee-extension strength 48h after fast-track TKA.METHODS: A total of 64 patients undergoing TKA were randomized (1:1) to the use of tourniquet (T-group) or no tourniquet (NT-group). In the T-group the tourniquet cuff pressure was based on the patient's systolic pressure and a margin of 100mmHg. It was inflated immediately before surgery and deflated as soon as surgery ended. The primary outcome was the change in knee-extension strength from pre-surgery to 48h after surgery (primary end point). Secondary outcomes were pain, nausea, length of hospital stay (LOS) and periarticular swelling.RESULTS: Knee-extension strength 48h after surgery was substantially reduced by about 90% in both groups, with no statistically significant difference between groups (mean difference 1.5N/kg, 95% CI 1.3-1.6). Among the secondary outcomes, the T-group had less bleeding during surgery (56 vs 182mL, P<0.01) compared with the NT-group. There was no difference in postoperative haemoglobin levels, pain, nausea, LOS or periarticular swelling between the groups.CONCLUSION: Not using a thigh tourniquet during surgery was not superior in preserving knee-extension strength at the primary endpoint 48h after fast-track TKA, compared to using a tourniquet.

AB - BACKGROUND: Thigh tourniquet is commonly used in total knee arthroplasty (TKA) but may contribute to pain and muscle damage. Consequently, the reduction in knee-extension strength after TKA may be caused by quadriceps muscle ischaemia underneath the cuff.AIM: To examine if not using a thigh tourniquet during surgery was more effective than using a thigh tourniquet in preserving knee-extension strength 48h after fast-track TKA.METHODS: A total of 64 patients undergoing TKA were randomized (1:1) to the use of tourniquet (T-group) or no tourniquet (NT-group). In the T-group the tourniquet cuff pressure was based on the patient's systolic pressure and a margin of 100mmHg. It was inflated immediately before surgery and deflated as soon as surgery ended. The primary outcome was the change in knee-extension strength from pre-surgery to 48h after surgery (primary end point). Secondary outcomes were pain, nausea, length of hospital stay (LOS) and periarticular swelling.RESULTS: Knee-extension strength 48h after surgery was substantially reduced by about 90% in both groups, with no statistically significant difference between groups (mean difference 1.5N/kg, 95% CI 1.3-1.6). Among the secondary outcomes, the T-group had less bleeding during surgery (56 vs 182mL, P<0.01) compared with the NT-group. There was no difference in postoperative haemoglobin levels, pain, nausea, LOS or periarticular swelling between the groups.CONCLUSION: Not using a thigh tourniquet during surgery was not superior in preserving knee-extension strength at the primary endpoint 48h after fast-track TKA, compared to using a tourniquet.

U2 - 10.1016/j.knee.2014.12.010

DO - 10.1016/j.knee.2014.12.010

M3 - Journal article

C2 - 25648580

VL - 22

SP - 126

EP - 130

JO - Knee

JF - Knee

SN - 0968-0160

IS - 2

ER -