Comparison of Tourniquet and Non-Tourniquet Use in Total Knee Arthroplasty: Impact on Postoperative Hemoglobin Changes and Surgical Time

Year 2025, , 43 - 49, 15.01.2025

Cumhur Deniz Davulcu , Muhammed Yusuf Afacan

https://doi.org/10.37990/medr.1554458

Abstract

Aim: This study aimed to evaluate the impact of pneumatic tourniquet use on postoperative hemoglobin (Hb) and hematocrit (Hct) levels, changes in Hb/Hct, and surgery duration in total knee arthroplasty (TKA) by comparing outcomes between patients who underwent the procedure with and without tourniquet application.
Material and Method: A retrospective cohort study was conducted on 130 patients with Kellgren-Lawrence grade 3-4 gonarthrosis who underwent TKA. Patients were divided into two groups, each with 65 patients, based on tourniquet use. Preoperative and postoperative day 1 Hb/Hct values, ΔHb/ΔHct, and surgery duration were compared. Patients with comorbidities and significant perioperative complications were excluded.
Results: No significant differences were found between the tourniquet and non-tourniquet groups for preoperative or postoperative Hb and Hct levels (p>0.05). Both groups experienced significant reductions in hemoglobin and hematocrit levels postoperatively. The non-tourniquet group had a slightly greater decrease in hemoglobin and hematocrit, although this difference was not statistically significant (p>0.05). The tourniquet group demonstrated a significantly shorter operation duration (p=0.004).
Conclusion: Tourniquet use in TKA reduces surgical time without significantly affecting blood loss. The comparable outcomes in both groups suggest that the use of a tourniquet may offer practical advantages, in terms of procedural efficiency in reducing surgical time, but its influence on postoperative Hb and Hct changes is minimal.

Keywords

Total knee arthroplasty, tourniquet use, hemoglobin change, hematocrit change, blood loss, surgical time

References

• Zhang HC, Zhang Y, Dai HB, et al. Preoperative anemia and complications after total joint arthroplasty: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci. 2022;26:7420-30.
• Albayrak M, Ugur F. With or without a Tourniquet? a comparative study on total knee replacement surgery in patients without comorbidities. Medicina (Kaunas). 2023;59:1196.
• Barros MFFH, Ribeiro EJC, Dias RG. Blood level changes in total knee arthroplasty with and without a tourniquet. Rev Bras Ortop. 2017;52:725-30.
• Tan Y, Guo S, Wang H, et al. The effects of tourniquet use on blood loss and perioperative complications in total knee arthroplasty. BMC Musculoskelet Disord. 2023;24:847.
• Afacan MY, Davulcu CD, Kaynak G, et al. A rare case of periprosthetic joint infection with streptococcus dysgalactiae subspecies dysgalactiae. Indian J Orthop. 2024;58:606-12.
• Parvizi J, Tan TL, Goswami K, et al. The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty. 2018;33:1309-14.e2.
• Aebischer AS, Hau R, de Steiger RN, et al. Distal femoral replacement for periprosthetic fractures after TKA: Australian Orthopaedic Association national joint replacement registry review. J Arthroplasty. 2022;37:1354-8.
• Richardson MK, Liu KC, Mayfield CK, et al. Tranexamic acid is safe in patients with a history of venous thromboembolism undergoing total joint arthroplasty. J Bone Joint Surg Am. 2024;106:30-8.
• Tai TW, Chang CW, Lai KA, et al. Effects of tourniquet use on blood loss and soft-tissue damage in total knee arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2012;94:2209-15.
• Zhang W, Li N, Chen S, et al. The effects of a tourniquet used in total knee arthroplasty: a meta-analysis. J Orthop Surg Res. 2014;9:13.
• Olivecrona C, Lapidus LJ, Benson L, Blomfeldt R. Tourniquet time affects postoperative complications after knee arthroplasty. Int Orthop. 2013;37:827-32.
• Yi S, Tan J, Chen C, et al. The use of pneumatic tourniquet in total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg. 2014;134:1469-76.
• Jiang FZ, Zhong HM, Hong YC, Zhao GF. Use of a tourniquet in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Orthop Sci. 2015;20:110-23.
• Groeneveld RA, Meeden G. Measuring Skewness and Kurtosis. The Statistician. 1984;33:391.
• Arthur JR, Spangehl MJ. Tourniquet use in total knee arthroplasty. J Knee Surg. 2019;32:719-29.
• Ishii Y, Matsuda Y. Effect of the timing of tourniquet release on perioperative blood loss associated with cementless total knee arthroplasty: a prospective randomized study. J Arthroplasty. 2005;20:977-83.
• Ishii Y, Matsuda Y. Effect of tourniquet pressure on perioperative blood loss associated with cementless total knee arthroplasty: a prospective, randomized study. J Arthroplasty. 2005;20:325-30.
• Huang Z, Ma J, Zhu Y, et al. Timing of tourniquet release in total knee arthroplasty. Orthopedics. 2015;38:445-51.
• Rama KRBS, Apsingi S, Poovali S, Jetti A. Timing of tourniquet release in knee arthroplasty. J Bone Jt Surg. 2007;89:699-705.
• Schnettler T, Papillon N, Rees H. Use of a tourniquet in total knee arthroplasty causes a paradoxical increase in total blood loss. J Bone Joint Surg Am. 2017;99:1331-6.
• Tirumala V, Klemt C, Oganseyan R, et al. Outcomes of tourniquet-less revision total knee arthroplasty: a matched cohort analysis. J Am Acad Orthop Surg. 2021;29:e1343-52.
• Cai DF, Fan QH, Zhong HH, et al. The effects of tourniquet use on blood loss in primary total knee arthroplasty for patients with osteoarthritis: a meta-analysis. J Orthop Surg Res. 2019;14:348.
• Zak SG, Tang A, Pivec R, et al. The effects of tourniquet on cement penetration in total knee arthroplasty. Arch Orthop Trauma Surg. 2023;143:2877-84.
• Huang CR, Pan S, Li Z, et al. Tourniquet use in primary total knee arthroplasty is associated with a hypercoagulable status: a prospective thromboelastography trial. Int Orthop. 2021;45:3091-100.
• Pavão DM, Pires eAlbuquerque RS, de Faria JLR, et al. Optimized tourniquet use in primary total knee arthroplasty: a comparative, prospective, and randomized study. J Arthroplasty. 2023;38:685-90.
• Johnsen M, Mousavizadeh R, Scott A, et al. The tourniquet's effects on skeletal muscle during total knee arthroplasty. J Orthop Res. 2024;42:1955-63.
• Xie J, Yu H, Wang F, et al. A comparison of thrombosis in total knee arthroplasty with and without a tourniquet: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2021;16:408.
• Nicolaiciuc S, Probst P, von Eisenhart-Rothe R, et al. Modern total knee arthroplasty (TKA): with or without a tourniquet?. Surg Technol Int. 2019;35:336-40.
• Smith TO, Hing CB. Is a tourniquet beneficial in total knee replacement surgery? A meta-analysis and systematic review. Knee. 2010;17:141-7.
• Joufflineau S, Thienpont E. Lower total blood loss in total knee arthroplasty with a low-pressure tourniquet than without. Acta Orthop Belg. 2021;87:461-8.
• Zan PF, Yang Y, Fu D, et al. Releasing of tourniquet before wound closure or not in total knee arthroplasty: a meta-analysis of randomized controlled trials. J Arthroplasty. 2015;30:31-7.
• Kim TK, Bamne AB, Sim JA, et al. Is lower tourniquet pressure during total knee arthroplasty effective? A prospective randomized controlled trial. BMC Musculoskelet Disord. 2019;20:275.
• Hung SH, Chiu FY, Cheng MF. A comparative study of the hemodynamic and clinical effects of using or not tourniquet in total knee arthroplasty. J Chin Med Assoc. 2023;86:529-33.
• Xu H, Yang J, Xie J, et al. Tourniquet use in routine primary total knee arthroplasty is associated with a higher transfusion rate and longer postoperative length of stay: a real-world study. BMC Musculoskelet Disord. 2020;21:620.
• Andrade MAP, Monte LFR, Lacerda GC, et al. Are cementation quality and clinical outcomes affected by the use of tourniquet in primary total knee arthroplasty?. Arch Orthop Trauma Surg. 2022;142:845-50.