Assessment of Blood Loss, Pain Score, and Functional Outcome in Patients Undergoing Bilateral Total Knee Arthroplasty with or without Tourniquet: A Randomized Controlled Study

Abstract Background: The most common affliction of the knee joint is osteoarthritis (OA), with a prevalence of 22%–39% in India. Total knee arthroplasty (TKA) is the standard definitive treatment in symptomatic patients of advanced OA. A tourniquet has been traditionally applied in TKA to achieve less intraoperative bleeding and create a bloodless surgical field for ease of surgery and to improve the quality of cementation leading to decreased surgical time. However, it also has certain complications, including but not limited to increased postoperative pain, deep vein thrombosis, pulmonary embolism, nerve palsy, vascular injury, and poor wound healing. This study was conducted to aid in the justification of the use of a tourniquet during TKA by comparing postoperative hematocrit, pain score, and knee function. Materials and Methods: This was a prospective, randomized controlled study conducted in the Department of Orthopedics, Fortis Hospital, Shalimar Bagh, New Delhi, on 60 patients undergoing bilateral TKA over 2 years from December 2017 to December 2019 to assess blood loss, pain score, and functional outcome in patients undergoing bilateral TKA with or without a tourniquet. Results: The mean age of patients undergoing bilateral TKA without a tourniquet was 64.07 ± 9.12 years, and for bilateral TKA with a tourniquet, it was 61.03 ± 8.07 years. The cumulative blood loss was found to be 795 mL without the use of a tourniquet, and when the tourniquet was used, it was calculated to be 690 mL. At the end of 3 months, there was no significant difference between the Visual Analog Scale scores of the two groups. Functional outcome evaluated using the Oxford Knee Score and Knee Society Score was statistically insignificant at 2 weeks, 6 weeks, and 3 months. Conclusion: From our study, we concluded that the use of a tourniquet decreases the intraoperative blood loss but has no role in reducing cumulative blood loss. However, it does not affect operating time, pain, functional outcomes, and quadriceps strength in a span of 3 months of follow-up. Hence, we suggest that rational thinking is required for the routine use of a tourniquet in every case of TKA.