Swapna Pran Saikia 1 , Nayan Moni Dutta
BACKGROUND To create a bloodless surgical field and to ensure less intraoperative bleeding, tourniquets are applied in total knee arthroplasty, which results in improvement of cementation quality, reducing time of surgery and ensuring implant fixing for a long term. Thigh pain, nerve palsy, ischaemia, damage of soft tissue, thromboembolism and poor wound healing and patella maltracking are the disadvantages of this technique. Due to reduced muscle strength, reduced knee ROM and increased pain, recovery may be delayed. Amongst the surgeons, the use of tourniquets is a common practise as it has many benefits such as it can enhance speed of procedure and recovery of patient. It minimises intraoperative blood loss, improves interdigitations of cement and bone and reduce the operative time. This study evaluates the effects of tourniquet use on functional and clinical outcome and on ROM of knee. The aim of the study is to evaluate the effects of tourniquet use on functional and clinical outcome and on ROM of knee. MATERIALS AND METHODS This was a prospective study, which was randomised and it was conducted on 100 patients in Jorhat Medical College, Jorhat, Assam, between March 2013 to March 2014. 100 patients were assessed for eligibility, however, 20 patients were excluded as they had diabetes mellitus with vascular disease peripherally (10), using anticoagulant (6) and refused to participate (4). The number of patients selected for randomisation were 80, out of which, one group allocated to tourniquet group (A) n=40, and other group, (B) in which, no tourniquet group; out of 40 in group A, 2 patients did not receive allocated intervention; in group B, 4 patients did not receive allocated intervention, i.e. preoperative switch to general anaesthesia. Hence, the total number of patients in group A who were analysed were 38 and total number of patients in group B who were analysed were 36. All the patients had signed, given informed consent and this study was approved by ethical committee. Inclusion Criteria- ASA physical status I-III, patients of age >45 years and 90, rheumatoid arthritis and allergy to any of the drugs used in the study. Using a ventral incision with a parapatellar medial entrance to the joint, TKA was performed. The patella was everted. A cemented single radius cruciate retaining total knee was used. RESULTS That there was an 85% knee extension strength reduction from 1.7 N/kg at baseline to 1.0 N/kg after surgery. However, after 48 hours post-surgery, there was no significant loss of knee extension strength. There was no differences in nausea, pain, LOS and periarticular swelling between the groups. There was no adverse events during the study. CONCLUSION This randomised study has concluded that without a tourniquet, a TKA surgery results in better TKA outcomes and improved knee ROM in early stages of rehabilitation.
