Modern Total Knee Arthroplasty (TKA): With Or Without a Tourniquet?

Background: Since arthritis of the knee is one of the most common pathologies in industrialized nations, there has been a growing interest in fast-track total knee arthroplasty (TKA). However, while one of the main concerns is the role of a tourniquet, the available data are inconclusive.
Aim: This study sought to assess the link between postoperative outcomes and use of a tourniquet in TKA. Our goal was to determine whether it is justified to forego tourniquet use as indicated by the fast-track concept.
Methods: The participants (n = 108) in this retrospective, non-randomized study were assigned into two groups after they satisfied the inclusion criteria: primary gonarthrosis or secondary gonarthrosis without previous arthrotomy. TKA was performed without (Group I, n = 55) or with (Group II, n = 53) a tourniquet. The postoperative outcome was evaluated in terms of postoperative pain, based on a numeric rating scale (NRS) and the need for pain medication, and postoperative function, based on range of motion (ROM) and walking tests.
Results: Overall, no significant correlations were observed between tourniquet use and postoperative pain according to the NRS. Group I required less oxycodone, but more non-opioids. There was no significant difference in the improvement in pre- to postoperative ROM with regard to tourniquet use. The final walking distance was significantly longer in Group I.
Conclusions: These results suggest that there is no strongly significant link between the postoperative outcome and the use of a tourniquet. However, further studies will be needed to determine whether a tourniquet may have some other impact on TKA.