Effects of tourniquet use on quadriceps function and pain in total knee arthroplasty

Abstract

Purpose: A pneumatic tourniquet is commonly used in total knee arthroplasty (TKA) to improve surgical field visualisation but may result in quadriceps muscle ischaemia. We performed this study to analyse the effect of the tourniquet on recovery following TKA.

Materials and methods: A prospective randomised single-blinded trial was undertaken to examine the effect of the tourniquet on post-operative pain, swelling, blood loss, quadriceps function and outcome following TKA. Twenty patients with osteoarthritis of the knee were randomised to tourniquet or no tourniquet groups. Quadriceps function was assessed using surface electromyography (EMG) during active knee extension.

Results: The no tourniquet group had significantly less pain in the early post-operative period compared to the tourniquet group. There was no difference in Oxford knee score, range of motion, or thigh and knee swelling up to 12 months post-operatively. Quadriceps function, measured by surface EMG, was compromised for the first six months post-surgery by tourniquet use. The radiological cement mantle at the bone prosthesis interface at 12-month follow-up was not affected by the absence of a tourniquet.

Conclusions: We believe that it is safe and beneficial for our patients to routinely perform TKA without a tourniquet.

Keywords: Arthroplasty; Knee; Pain; Quadriceps; Tourniquet.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1

Consolidated standards of reporting trials (consort) flow diagram for the study.

Fig. 2

Average pain scores for the first 5 days post-operatively in the tourniquet and no tourniquet groups.

Fig. 3

Thigh circumference comparison between the tourniquet and no tourniquet groups. Preop: preoperative.

Fig. 4

Knee circumferences for the tourniquet and no tourniquet groups.

Fig. 5

Surface electromyography (EMG) in the tourniquet (T) and no tourniquet (NT) groups. T1 represents the pre-operative measurements, with T2, T3 and T4 measurements are at the 6 week, 6 month and 2 month follow-up periods. VAM, VAL and RF stand for vastus medialis, vastus lateralis and rectus femoris respectively. VAM: vastus medialis, VAL: vastus lateralis, RF: rectus femoris.

Fig. 6

Femoral cement penetration in Knee Society radiographic zone.

Fig. 7

Tibial cement penetration in Knee Society anteroposterior radiographic zones.

Fig. 8

Tibial cement penetration in Knee Society mediolateral radiographic zones.