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.

Abstract

Tourniquets are used in knee arthroplasty surgeries for a bloodless field and effective bone-cement integration. However, their use is associated with known complications and of late surgeons have proposed limiting their use. The present randomized study was carried out to analyze the effectiveness of limited tourniquet usage in knee arthroplasty. 60 patients were randomized into two groups, full tourniquet time (FTT) group and the limited tourniquet time (LTT) group. 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 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. Tourniquet usage is associated with known complications. There is no significant advantage in blood loss while using tourniquet throughout the surgery. However, limiting the tourniquet use is associated with significantly lower pain scores on 5th post-op day. Hence, it is recommended that the use should be reduced to mitigate the complications of tourniquet usage.