TY - JOUR
T1 - Tourniquet versus no tourniquet on knee-extension strength early after fast-track total knee arthroplasty; a randomized controlled trial
AU - Harsten, Andreas
AU - Bandholm, Thomas Quaade
AU - Kehlet, Henrik
AU - Toksvig-Larsen, Sören
N1 - Copyright © 2015 Elsevier B.V. All rights reserved.
PY - 2015/3/1
Y1 - 2015/3/1
N2 - Background: Thigh tourniquet is commonly used in total knee arthroplasty (TKA) but may contribute to pain and muscle damage. Consequently, the reduction in knee-extension strength after TKA may be caused by quadriceps muscle ischaemia underneath the cuff. Aim: To examine if not using a thigh tourniquet during surgery was more effective than using a thigh tourniquet in preserving knee-extension strength 48. h after fast-track TKA. Methods: A total of 64 patients undergoing TKA were randomized (1:1) to the use of tourniquet (T-group) or no tourniquet (NT-group). In the T-group the tourniquet cuff pressure was based on the patient's systolic pressure and a margin of 100. mm. Hg. It was inflated immediately before surgery and deflated as soon as surgery ended. The primary outcome was the change in knee-extension strength from pre-surgery to 48. h after surgery (primary end point). Secondary outcomes were pain, nausea, length of hospital stay (LOS) and periarticular swelling. Results: Knee-extension strength 48. h after surgery was substantially reduced by about 90% in both groups, with no statistically significant difference between groups (mean difference 1.5. N/kg, 95% CI 1.3-1.6). Among the secondary outcomes, the T-group had less bleeding during surgery (56 vs 182. mL, P<. 0.01) compared with the NT-group. There was no difference in postoperative haemoglobin levels, pain, nausea, LOS or periarticular swelling between the groups. Conclusion: Not using a thigh tourniquet during surgery was not superior in preserving knee-extension strength at the primary endpoint 48. h after fast-track TKA, compared to using a tourniquet.
AB - Background: Thigh tourniquet is commonly used in total knee arthroplasty (TKA) but may contribute to pain and muscle damage. Consequently, the reduction in knee-extension strength after TKA may be caused by quadriceps muscle ischaemia underneath the cuff. Aim: To examine if not using a thigh tourniquet during surgery was more effective than using a thigh tourniquet in preserving knee-extension strength 48. h after fast-track TKA. Methods: A total of 64 patients undergoing TKA were randomized (1:1) to the use of tourniquet (T-group) or no tourniquet (NT-group). In the T-group the tourniquet cuff pressure was based on the patient's systolic pressure and a margin of 100. mm. Hg. It was inflated immediately before surgery and deflated as soon as surgery ended. The primary outcome was the change in knee-extension strength from pre-surgery to 48. h after surgery (primary end point). Secondary outcomes were pain, nausea, length of hospital stay (LOS) and periarticular swelling. Results: Knee-extension strength 48. h after surgery was substantially reduced by about 90% in both groups, with no statistically significant difference between groups (mean difference 1.5. N/kg, 95% CI 1.3-1.6). Among the secondary outcomes, the T-group had less bleeding during surgery (56 vs 182. mL, P<. 0.01) compared with the NT-group. There was no difference in postoperative haemoglobin levels, pain, nausea, LOS or periarticular swelling between the groups. Conclusion: Not using a thigh tourniquet during surgery was not superior in preserving knee-extension strength at the primary endpoint 48. h after fast-track TKA, compared to using a tourniquet.
U2 - 10.1016/j.knee.2014.12.010
DO - 10.1016/j.knee.2014.12.010
M3 - Journal article
C2 - 25648580
SN - 0968-0160
VL - 22
SP - 126
EP - 130
JO - Knee
JF - Knee
IS - 2
ER -