Gibbs Brian, Sniderman Jhase, Mohammed Shariq, Kain Michael, Freccero David, Abdeen Ayesha
Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Massachusetts.
Department of Orthopaedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
J Bone Joint Surg Am. 2025 May 7;107(9):976-984. doi: 10.2106/JBJS.24.00266. Epub 2025 Mar 20.
Total knee arthroplasty (TKA) is one of the most commonly performed elective procedures in North America. While advancements have been made in patient optimization, surgical technique, and implant design, tourniquet use remains a contentious issue as it relates to patient outcomes and postoperative experience.
As part of the PEPPER trial, we identified 5,684 patients who underwent primary TKA, of whom 4,866 (85.6%) underwent surgery with a tourniquet (the YT group) and 818 (14.4%) underwent surgery without a tourniquet (the NT group). The cohort was predominantly female (60.8%), White (77%), and of an ethnicity other than Hispanic or Latino (96.8%). The mean age of the patients was 64.6 ± 9.2 years. The primary outcomes were the Knee injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS JR); Patient-Reported Outcomes Measurement Information System Physical Health Summary (PROMIS-PH10); and numeric pain rating scale (NPRS), which were captured preoperatively and at 1, 3, and 6 months postoperatively. The secondary outcomes were length of stay, discharge disposition, analgesic consumption, and postoperative complications. Multivariable analysis was performed to assess the associations between tourniquet use and patient-reported outcome measures (PROMs) following TKA.
The percentages of patients achieving the minimal clinically important difference (MCID) for the KOOS JR were significantly different at 1 month only (YT, 55.4%; NT, 47.9%). This difference disappeared at 3 and 6 months. There was no difference between the YT and NT groups in terms of the percentage of patients achieving the MCID for the PROMIS-PH10 or NPRS at any time point. There were no differences between the YT and NT groups at any time point with respect to the KOOS JR, PROMIS-PH10, and NPRS. There were no differences in opioid consumption, operative time, length of stay, wound-related complications, or readmissions postoperatively.
Tourniquet use was associated with more patients achieving the MCID for the KOOS JR at 1 month compared with no tourniquet use. This difference disappeared at 3 and 6 months. At 1, 3, and 6 months, there were no differences in opioid consumption, health-care utilization, or complications between patients undergoing TKA with a tourniquet versus without a tourniquet. Tourniquet use did not have a clinically meaningful impact on PROMs in the multivariable analysis. Arthroplasty surgeons may use these data during preoperative discussions with patients regarding tourniquet use as it relates to the surgeon's preference and how it could influence postoperative function.
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
全膝关节置换术（TKA）是北美最常进行的择期手术之一。尽管在患者优化、手术技术和植入物设计方面取得了进展，但止血带的使用仍是一个有争议的问题，因为它与患者预后和术后体验有关。
作为PEPPER试验的一部分，我们确定了5684例行初次TKA的患者，其中4866例（85.6%）使用止血带进行手术（YT组），818例（14.4%）未使用止血带进行手术（NT组）。该队列主要为女性（60.8%）、白人（77%），且非西班牙裔或拉丁裔（96.8%）。患者的平均年龄为64.6±9.2岁。主要结局指标为膝关节损伤和骨关节炎结局评分、关节置换（KOOS JR）；患者报告结局测量信息系统身体健康总结（PROMIS-PH10）；以及数字疼痛评分量表（NPRS），在术前、术后1个月、3个月和6个月进行记录。次要结局指标为住院时间、出院处置、镇痛药物使用量和术后并发症。进行多变量分析以评估TKA后止血带使用与患者报告结局指标（PROMs）之间的关联。
仅在术后1个月时，达到KOOS JR最小临床重要差异（MCID）的患者百分比在两组间存在显著差异（YT组为55.4%，NT组为47.9%）。这种差异在术后3个月和6个月时消失。在任何时间点，YT组和NT组在达到PROMIS-PH10或NPRS的MCID的患者百分比方面均无差异。在任何时间点，YT组和NT组在KOOS JR、PROMIS-PH10和NPRS方面均无差异。两组在阿片类药物使用量、手术时间、住院时间、伤口相关并发症或术后再入院方面均无差异。
与不使用止血带相比，使用止血带的患者在术后1个月时达到KOOS JR的MCID的人数更多。这种差异在术后3个月和6个月时消失。在术后1个月、3个月和6个月时，使用止血带与未使用止血带的TKA患者在阿片类药物使用量、医疗保健利用率或并发症方面均无差异。在多变量分析中，止血带的使用对PROMs没有临床意义上的影响。关节置换外科医生在术前与患者讨论止血带使用时，可参考这些数据，因为这涉及医生的偏好以及其对术后功能的影响。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
