Limited tourniquet application in primary unilateral TKA may not increase incidence of perioperative complications: study

Limited tourniquet application in primary unilateral TKA does not increase the incidence of perioperative complications: study

Tourniquet application in total knee arthroplasty (TKA) has many benefits and may have a role in the incidence of perioperative complications. Doried Diri et al conducted a study to examine the safety of applying a tourniquet for a limited amount of time during primary unilateral TKA (specifically, during cementation and final component fixation only) and to compare perioperative complications between the limited-application group and the full-application group. The study was conducted at Damascus University, Damascus, Syria. It has been published in ‘JBJS Open Access’.

The authors conducted a randomized controlled study of 62 patients undergoing primary unilateral TKA. Patients were randomly allocated to either the limited or full tourniquet application. The follow-up period was 6 months. They evaluated intraoperative, postoperative, total, and hidden blood loss as the primary outcome measures and clearance of the surgical field, operative duration, and perioperative complications as the secondary outcome measures.

Key findings of the study were:

• No patients were lost to follow-up and all patients attended their follow-up visits.

• No significant differences in patient demographics and characteristics were found between treatment groups

• Surgical field clearance, as evaluated by the surgeon, was significantly different between the groups.

• There was no significant difference in total, hidden, or postoperative blood loss between the groups.

• Mean intraoperative blood loss was significantly lower in the full-application group than in the limited-application group (171.742 ± 19.710 versus 226.258 ± 50.290 mL; p = 0.001).

• The mean (and standard deviation) operative duration was 56.177 ± 6.075 minutes. Operative duration did not differ significantly between the groups

• Perioperative complications, including allogeneic blood transfusion rates, did not significantly differ between the groups.

The authors concluded – “The use of limited tourniquet application is safe for low-risk patients undergoing primary unilateral TKA performed by an expert surgeon. When compared with the full application regimen, the limited application regimen showed no increased rates of perioperative complications or total blood loss”

Level of Evidence: Therapeutic Level I.

Further reading:

Blood Loss in Primary Unilateral Total Knee Arthroplasty with Limited Tourniquet Application A Randomized Controlled Trial

Doried Diri et al

JBJS Open Access 2023:e23.00020.

http://dx.doi.org/10.2106/JBJS.OA.23.00020