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

Year 2025, Volume: 7 Issue: 1, 43 - 49
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.

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.
Year 2025, Volume: 7 Issue: 1, 43 - 49
https://doi.org/10.37990/medr.1554458

Abstract

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.
There are 35 citations in total.

Details

Primary Language English
Subjects Orthopaedics
Journal Section Original Articles
Authors

Cumhur Deniz Davulcu 0000-0002-6444-5047

Muhammed Yusuf Afacan 0000-0003-4940-4711

Publication Date
Submission Date September 22, 2024
Acceptance Date October 19, 2024
Published in Issue Year 2025 Volume: 7 Issue: 1

Cite

AMA Davulcu CD, Afacan MY. Comparison of Tourniquet and Non-Tourniquet Use in Total Knee Arthroplasty: Impact on Postoperative Hemoglobin Changes and Surgical Time. Med Records. 7(1):43-49. doi:10.37990/medr.1554458

17741

Chief Editors

Assoc. Prof. Zülal Öner
Address: İzmir Bakırçay University, Department of Anatomy, İzmir, Türkiye

Assoc. Prof. Deniz Şenol
Address: Düzce University, Department of Anatomy, Düzce, Türkiye

E-mail: medrecsjournal@gmail.com

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