LIMITED USE VERSUS TOTAL USE OF TOURNIQUET IN PRIMARY TOTAL KNEE ARTHROPLASTY

Background: Tourniquets are used during total knee arthroplasty for better surgical fields and improved cementation. The functional benefits of tourniquet application for limited periods compared with total duration applications during total knee joint arthroplasty (TKA) surgery have not been well explored. Aim of the study: To evaluate and compare the outcomes of limited use of a tourniquet (LT) for a shorter duration (just before cement application) with total use of a tourniquet (TT) for a longer duration (from skin incision to the completion of surgery). Patients and method: A sum of 100 patients who undertook primary total knee arthroplasty were involved in this study, they were allocated randomly into two groups according to whether a limited or total tourniquet was used during the surgery. Both groups underwent the same surgical procedures with a digital tourniquet applied to all patients using the same technique. Intraoperative and postoperative assessment of blood loss, knee functional society score (KSS), visual analogue score (VAS) for thigh pain and knee pain evaluation, surgical complications like deep vein thrombosis (DVT), wound infections and nerve injuries are the main factors evaluated in the study. Results: Patients with LT required more intraoperative blood transfusion compared with those with TT who required more blood transfusion postoperatively. There were no significant differences in KSS, VAS for thigh pain and knee pain evaluation, and surgical complications like DVT, wound infections and nerve injuries. Conclusion: Limited tourniquet application from starting of cementing is associated with a higher need for intraoperative blood transfusion, but the use of a TT throughout surgery is associated with a higher need for postoperative blood transfusion.