Limited Torniquet application tied to superior pain scores in early post-operative period in TKR surgeries: study

For patients in the FTT group, the tourniquet was inflated following cleaning, draping and elevation for 5 min, just before the skin incision. In the LTT group, the tourniquet was inflated after bone cuts were completed and trialing done just prior to implant cementation. In both groups, the tourniquet was deflated only after the conclusion of the procedure and application of postoperative dressings. No local infiltration of vasoconstrictor drugs or analgesic cocktails was used either of the groups during surgery. Suction drains were routinely used and removed on the first post-operative day.

Demographic parameters, preoperative haemoglobin and haematocrit, operative time, duration of tourniquet use, and measured blood losses were recorded. Drain outputs, post-operative Hb, hematocrit, transfusion requirements, total blood loss by day 5 were recorded and calculated. Hidden blood loss was calculated based on the above-derived data.

The key findings of the study were:

• The demographic and the pre-operative variables of the two groups were similar.

• On intra-group analysis, all the parameters were statistically significant except the VAS scores.

• On comparison between the two groups the tourniquet time, day 1 Hb in the FTT group and pain experienced by the FTT group on day 5 was significantly higher whereas the operative time LTT group was significantly higher.There was no significant difference in the rest of the parameters.

The authors commented - “The main purpose of tourniquet use in knee arthroplasty has been to provide a bloodless fi eld especially during cementation, reduce blood loss and perhaps operative time. The limited use of a tourniquet in our study allowed us a dry bed during cementation at the expense of a slightly higher operative time and similar total blood losses. Seemingly, the only benefit which accrued was the significant reduction in patient discomfort by day 5 in the LTT group. Based upon this study, a few of us recommend limiting the duration of tourniquet use from cementation to closure during total knee arthroplasty since it is associated with superior pain scores in the early post-operative period while the rest await further data. We advocate the use of Tranexamic acid unless specifically contraindicated. We also recommend a well-calibrated tourniquet device with lower pressure settings calibrated as per the patient to mitigate complications.”

Further reading:

A Single Blinded Randomised Controlled Study on Effectiveness in Controlling Blood Loss and the Short-Term Outcomes of Limited Tourniquet Use in Primary Total Knee Arthroplasty Chander Mohan Singh et al Indian Journal of Orthopaedics (2025) 59:1455–1461 https://doi.org/10.1007/s43465-025-01452-z