A staged use of tourniquet does not influence the fast-track recovery after total knee arthroplasty: a prospective randomized study

Paolo Salari; Giovanni Balato; Giuseppe Cavallo; Vanni Strigelli; Andrea Meccariello; Andrea Baldini

doi:10.1007/s00402-024-05300-x

A staged use of tourniquet does not influence the fast-track recovery after total knee arthroplasty: a prospective randomized study

Arch Orthop Trauma Surg. 2024 Apr 3. doi: 10.1007/s00402-024-05300-x. Online ahead of print.

Authors

Paolo Salari¹, Giovanni Balato², Giuseppe Cavallo^{3

4}, Vanni Strigelli⁵, Andrea Meccariello⁶, Andrea Baldini³

Affiliations

¹ Istituto Fiorentino di Cura e Assistenza (IFCA), via del Pergolino 4/6, Florence, 50139, Italy. paul.s.89@hotmail.it.
² Department of Public Health, School of Medicine, Federico II University, Via S. Pansini, Naples, 80131, Italy.
³ Istituto Fiorentino di Cura e Assistenza (IFCA), via del Pergolino 4/6, Florence, 50139, Italy.
⁴ Department of Health Science, University of Florence, Viale GB Morgagni 48, Florence, 50134, Italy.
⁵ Valdisieve Hospital Florence, via Forlivese 122, San Francesco (Florence), 50060, Italy.
⁶ Ospedale dei Pellegrini, Asl Napoli 1 Centro, Naples, 80122, Italy.

PMID: 38568385
DOI: 10.1007/s00402-024-05300-x

Abstract

Introduction: Upper-tight tourniquet is widely used in Total Knee Arthroplasty in different modalities. However, it has been associated with a negative impact on post-operative muscle strength end pain. This study aimed to investigate the effect of tourniquet on post-operative pain and recovery in enhanced recovery joint surgery.

Materials and methods: In this prospective randomized study, we included 116 patients undergoing to TKA. Surgery was performed with a staged use of tourniquet in Group A (58 patients) and without tourniquet in Group B. In the former group a low-pressure tourniquet was deflated after bone cuts to allow hemostasis of posterior recess and re-inflated for cementation. For all patients a multimodal fast-track recovery protocol was used. Time to reach rehabilitation milestones was recorded as primary endpoint. Range of motion, pain, hemarthrosis, total blood loss, surgical field visualization, Knee Score (KS) and Oxford Knee Score (OKS) were considered as secondary outcomes.

Results: . No statistically significant differences were found (group B: average 1.3 ± 0.6 day; group A: average 1.2 ± 0.5 day). Group A had a shorter mean surgical time and a clearer surgical field visualization. Group B had a larger estimated blood loss and hemoglobin drop without a statistically significant difference in the transfusion rate. No differences between the groups were seen in the KS, OKS and range of motion (ROM) and post-operative joint swelling. Pain score was similar between cohorts and recorded thigh pain was surprisingly greater in group B.

Discussion: The use of tourniquet in TKA surgery helps to minimize intraoperative blood loss and improves surgical field visualization. Its application with a modern and staged protocol does not affect the functional outcomes (OKS, KSS, ROM) of the early post operative period without compromising the fast-track recovery.

Keywords: Blood loss; Fast recovery; Fast track; Swelling; TKA; Tourniquet; Tranfusion.