Tourniquet Use Does Not Impact Trajectory of Total Knee Arthroplasty Early Recovery: study

The impact of tourniquet use on recovery after total knee arthroplasty (TKA) remains controversial. C.M. Lawrie et al conducted a prospective, single blinded, randomized controlled trial to investigate the effect of tourniquet use on early recovery after TKA using a smartphone app based patient engagement platform (PEP) with a wrist-based activity monitor to obtain more robust data on early recovery.

This study has been awarded “Chitranjan S. Ranawat Award” at the 2023 knee society awards. The study has been published in ‘The Journal of Arthroplasty.’

There were 107 patients undergoing primary TKA for osteoarthritis who were enrolled (54 tourniquet [TQ+]; 53 no tourniquet [TQ-]). All patients utilized a PEP and wrist-based activity sensor for 2 weeks preoperatively and 90 days postoperatively to collect Visual Analog Scale (VAS) pain scores and opioid consumption, as well as weekly Oxford Knee Score (OKS) and monthly Forgotten Joint Score (FJS). There was no difference in demographics between groups. Formal physical therapy assessments were performed preoperatively and 3 months postoperatively. Independent sample t-tests were used for continuous data and Chi-square and Fisher’s exact tests were used for discrete data.

Key findings of the study were:

• Tourniquet use did not have a statistically significant impact on daily VAS pain or opioid consumption during the first 30 days postoperatively (P > .05).

• Tourniquet use did not have a significant impact on OKS or FJS at 30 or 90 days postoperatively (P > .05), or on performance of formal physical therapy testing at 3 months postoperatively (P > .05).

• No significant differences were found between groups for any of the physical therapy performed functional assessments preoperatively or at 3 months postoperative.

“In conclusion, we have demonstrated that tourniquet use has no impact on objective functional recovery as assessed by wearable activity monitor during the first 30 days postoperatively. Additionally, we found no clinically significant increased pain or opioid requirement in patients who had a tourniquet used for their procedure. Also, no difference between the tourniquet and tourniquetless groups were found in traditional PROMs measured at 4 and 12 weeks postoperatively and in formal objective physical therapy assessment at 12 weeks postoperatively” – the authors commented.

Further reading:

Tourniquet Use Does Not Impact Trajectory of Total Knee Arthroplasty Early Recovery: A Prospective, Randomized Controlled Trial Charles M. Lawrie, Charles P. Hannon et al The Journal of Arthroplasty 38 (2023) S7-S13 https://doi.org/10.1016/j.arth.2023.03.081