Tourniquet use during TKA does not significantly alter blood loss: study

The use of a tourniquet has become widely accepted as standard practice during total knee arthroplasty (TKA). There are conflicting outcomes in using a tourniquet during TKA. This brings to question the role a tourniquet has in TKA. Therefore, Patrick Riggle et al conducted a retrospective cohort study to examine the effects of TKA with and without the use of a tourniquet.

The study has been published in 'Arthroplasty Today' journal.

A total of 120 patients (n = 60 underwent TKA with tourniquet and n = 60 underwent TKA without tourniquet) were included in this study. Patient medical records were retrospectively reviewed for preoperative and postoperative data. The Gross formula, a validated formula for calculating blood loss, was used to calculate each patient's total blood loss. Statistical analysis was performed using in dependent t-tests, Mann-Whitney U tests, and/or chi-square tests. Significance was determined using an alpha level of P < .05.

Key findings of the study were:

•There were no statistically significant differences (P < .05) between groups with regards to age, sex, body mass index, preoperative hemoglobin and hematocrit, and American Society of Anesthesiologists score

•There was no statistically significant difference (P = .49) in the amount of total blood loss between patients undergoing TKA with a tourniquet and those without (199.6 ± 92.2 mL vs 211.1 ± 88.1 mL, respectively).

•There were statistically significant differences in the operating room time (P = .005), surgery time (P = .008), and functional return of postoperative straight leg raise (P < .001) between groups.

•There were no intraoperative or immediate postoperative complications observed in either group, and no transfusions were required during the hospital stay of any patients.

The authors commented – "In conclusion, based on the result of our study, there was no statistically significant difference in the amount of total blood loss between patients undergoing TKA with a tourniquet and those without. Furthermore, there were statistically significant differences in the OR time, surgery time, and functional return of postoperative SLR ability between groups. This study supports existing evidence that tourniquet use does not alter blood loss in TKA and presents evidence that using a tourniquet during TKA may add additional cost and increase surgical time without benefit." 

Key Words: Tourniquet, Total knee arthroplasty, Blood loss, TKA, Patrick Riggle, Arthroplasty Today

Further reading:

Efficacy of Tourniquet Use in Total Knee Arthroplasty: A Retrospective Cohort Review Patrick Riggle, Paul A. Ulrich et al Arthroplasty Today 17 (2022) 155 - 158 https://doi.org/10.1016/j.artd.2022.08.010