Spinal anesthesia combined with a tourniquet provided favorable TKA outcomes
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According to published results, spinal anesthesia combined with the use of a tourniquet resulted in increased Oxford Knee Score and favorable outcomes for patients who underwent total knee arthroplasty.
To compare the effects of tourniquet use, spinal anesthesia (SA) and general anesthesia (GA) on patients who underwent TKA, Mikko Rantasalo, MD, and colleagues assigned 404 patients to one of the following study groups: SA without a tourniquet (NT/SA), SA with a tourniquet (T/SA), GA without a tourniquet (NT/GA) or GA with a tourniquet (T/GA).
According to the study, primary outcome measures included the Oxford Knee Score (OKS), OKS minimal important change (MIC), OKS patient acceptable symptom state (PASS), adverse events and quality of life.
At 1-year follow-up, OKS was recorded for 381 patients. Rantasalo and colleagues found SA combined with the use of tourniquet resulted in the best improvements in OKS and the largest proportion of satisfactory outcomes. The T/SA group had an OKS improvement of 16.87 compared with 13.65 in the NT/GA group. The T/SA group also reached the OKS MIC and OKS PASS more frequently than the NT/GA group, according to the study.
In a two-group comparison, researchers found tourniquet use had no detrimental effects on OKS or TKA outcomes. They also noted no differences in adverse events between any groups.
“At 1 year, we found that all studied regimens were equally effective and safe in TKA in terms of the OKS and adverse events, as hypothesized,” Rantasalo and colleagues wrote in the study. “Interestingly, the combination of a tourniquet and SA was associated with the most substantial improvements in the OKS. Even though the difference in the total OKS remained below the MID, the difference in the gain in the OKS (approximately 3.2 points) between the T/SA and NT/GA groups is noteworthy,” they added.
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