Randomized Control Trial Comparing Effects of Tourniquets on Neurology and Functional Outcomes after Total Knee Arthoplasty

Abstract

Introduction: Total knee arthroplasty (TKA) often uses a tourniquet to enhance surgical visualization and reduce intraoperative blood loss. Despite its benefits, tourniquet use is associated with several complications such as skin blistering, nerve palsy, and deep vein thrombosis. The literature reveals a divided opinion on whether TKA should be performed with or without a tourniquet, with conflicting results on post-operative pain, blood loss, and functional outcomes.. Materials and Methods: This study included patients aged 65 to 90 years undergoing elective unilateral TKA for osteoarthritis. Exclusion criteria included patients with a Body mass index ≥35, rheumatoid arthritis, peripheral vascular disease, diabetes, prior knee surgery, and on anticoagulation medication. The study focused on comparing the neurology through nerve conduction studies and functional outcomes of TKA performed with and without a tourniquet. Some key metrics included intraoperative blood loss, surgical duration, post-operative pain, analgesic use, and range of motion (ROM). Results: The study recruited 55 patients aged ranging from 65 to 90 years who were randomized into two groups.22 patients were excluded, and the final analysis involved 23 patients. Tourniquet use resulted in lower blood loss (140 mL vs. 215 mL) and shorter operative times (87 min vs. 95 min) compared to the non-tourniquet group. However, the tourniquet group had higher incidences of nerve palsy in the immediate post-operative period as compared to the other group. Both the groups showed significant improvements in post-operative ROM, but the tourniquet group had higher post-operative pain and analgesic requirements, and this was statistically significant. Conclusion: Tourniquet use in TKA reduces intraoperative blood loss and operative time but is associated with a higher risk of nerve-related complications and increased post-operative pain. The findings suggest that avoiding tourniquet use may lead to better overall clinical outcomes and early post-operative ROM.

Keywords

• tourniquets
• total knee replacement
• arthroplasty
• nerve conduction study
• nerve injury