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Tourniquet use did not change TKA surgical factors
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DALLAS — A randomized controlled trial conducted to study results of total knee arthroplasty performed by four orthopedic surgeons at two sites with and without use of a tourniquet showed no negative impact postoperatively among patients who were randomized to undergo surgery with a tourniquet.
At the American Association of Hip and Knee Surgeons Annual Meeting, Ran Schwarzkopf, MD, presented findings of the analyses he and his colleagues did into some of the surgical variables that are theorized to be affected by tourniquet use during TKA, which included VAS pain scores, patient-reported outcomes, length of stay and readmissions.
“It is an ongoing study” of 228 patients, said Schwarzkopf, who presented results for 70 patients; 37 patients in the non-tourniquet group and 33 patients in the tourniquet group. The groups were similar in terms of their demographics, he noted.
All the tourniquets were inflated to 250 mm hg, Schwarzkopf said.
“When we look at surgical outcomes, surgical time, inpatient, morphine, length of stay, VAS scores on the day of surgery and 1 day, they’re equivalent. [There was] a little bit less blood loss ... in the tourniquet group. It was significant. I do not think it was clinically significant,” Schwarzkopf said.
“In conclusion, tourniquet use in this study, and other studies, does not change surgical factors,” he said.
Schwarzkopf added, “I think use of the tourniquet should be left to the surgeon.” – by Susan M. Rapp
Reference:
Padilla J, et al. Paper 8. Presented at: American Hip and Knee Surgeons Annual Meeting; Nov. 7-10, 2019; Dallas.
Disclosure: Schwarzkopf reports he receives stock or stock options from Gauss Surgical and is a paid consultant for and receives research support from Smith & Nephew.
Perspective
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Matthew S. Austin, MD
I listened with great interest to this podium presentation at the AAHKS Annual Meeting. The decades old debate of whether to utilize a tourniquet during TKA procedures continues to warrant further investigation. In this prospective randomized controlled trial, Schwarzkopf and his colleagues from NYU/Hospital for Joint Diseases in New York found no difference in surgical time, length-of-stay, pain scores, in-patient opioid consumption, out-patient opioid consumption, patient-reported outcomes or readmissions. They concluded that tourniquet use during TKA does not have an impact on outcomes. This study further expands on recently published work from our institution by Rahul Goel, MD, and colleagues. Both studies demonstrated no difference in measures of function and pain with use of a tourniquet. These results are in conflict with some previously published literature that showed a detrimental effect with tourniquet use. Therefore, the debate will continue to rage on as more high-quality studies are needed to put this issue to rest.
Reference:
Goel R, et al. J Bone Joint Surg Am. 2019;doi:10.2106/JBJS.19.00146.
Rothman Orthopaedics at Sidney Kimmel Medical College
Philadelphia
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