Evaluating tourniquet duration in total knee replacement: short-term outcomes of short versus long durations, a randomized controlled trial

Background Total knee arthroplasty (TKA) is an effective treatment for severe osteoarthritis. We aim to compare the advantages and disadvantages related to the duration of tourniquet application in TKA surgeries. Patients and methods This multicenter randomized controlled trial was conducted at two tertiary institutions by including 50 grade IV knee primary osteoarthritis cases who were candidates for TKA and randomized them to group one, including 25 patients who underwent long-duration applying of tourniquet (applied from skin incision through the end of bone cementation) and group two including other 25 patients who underwent short duration applying of tourniquet (applied only during bone cementation and deflated immediately afterward). Operative outcomes were assessed including operation time in minutes, hospital stay in days, intraoperative and postoperative blood loss (212±24.49 vs. 303.2±23.76 ml), and the need for blood transfusion. Functional outcomes were assessed like the range of motion (ROM), pain visual analog scale, knee society score, and Oxford knee score. Finally, wound complications and thromboembolic events were compared between both groups. Results Group one with long tourniquet application had decreased operative time 87.4±5.23 versus 97.4±4.36 min ( P <0.001) and decreased intraoperative bleeding ( P <0.001) compared with group two which favored the group one technique. On the other hand, group two had decreased postoperative bleeding ( P <0.001), decreased visual analog scale pain score in all follow-up periods ( P <0.001), increased ROM and knee society score in all follow-up periods ( P <0.001), and increased Oxford knee score only after 1 week of follow-up ( P <0.001) compared with group one which favored the short tourniquet application group. Conclusion The short application duration of the tourniquet provided superior pain alleviation in the early postoperative period and improved functional outcomes and ROM. However, this results in a greater loss of blood extended the length of the operation, and prevented a clear view of the operative region.