Sidhu Gur-Aziz Singh, Pattnaik Saphalya, Gawad Mothana, Ghani Rafia, Kaur Harjot, Ashwood Neil
Department of Trauma and Orthopaedics, University Hospital Lewisham, London, United Kingdom.
Department of Anesthesia, Guys and St Thomas Hospital, London, United Kingdom.
J Orthop Case Rep. 2025 Aug;15(8):294-299. doi: 10.13107/jocr.2025.v15.i08.5974.
Total knee arthroplasty (TKA) often uses a tourniquet to enhance surgical visualization and reduce intraoperative blood loss. Despite its benefits, tourniquet use is associated with several complications such as skin blistering, nerve palsy, and deep vein thrombosis. The literature reveals a divided opinion on whether TKA should be performed with or without a tourniquet, with conflicting results on post-operative pain, blood loss, and functional outcomes..
This study included patients aged 65 to 90 years undergoing elective unilateral TKA for osteoarthritis. Exclusion criteria included patients with a Body mass index ≥35, rheumatoid arthritis, peripheral vascular disease, diabetes, prior knee surgery, and on anticoagulation medication. The study focused on comparing the neurology through nerve conduction studies and functional outcomes of TKA performed with and without a tourniquet. Some key metrics included intraoperative blood loss, surgical duration, post-operative pain, analgesic use, and range of motion (ROM).
The study recruited 55 patients aged ranging from 65 to 90 years who were randomized into two groups.22 patients were excluded, and the final analysis involved 23 patients. Tourniquet use resulted in lower blood loss (140 mL vs. 215 mL) and shorter operative times (87 min vs. 95 min) compared to the non-tourniquet group. However, the tourniquet group had higher incidences of nerve palsy in the immediate post-operative period as compared to the other group. Both the groups showed significant improvements in post-operative ROM, but the tourniquet group had higher post-operative pain and analgesic requirements, and this was statistically significant.
Tourniquet use in TKA reduces intraoperative blood loss and operative time but is associated with a higher risk of nerve-related complications and increased post-operative pain. The findings suggest that avoiding tourniquet use may lead to better overall clinical outcomes and early post-operative ROM.
全膝关节置换术（TKA）通常使用止血带来增强手术视野并减少术中失血。尽管有其益处，但使用止血带会引发多种并发症，如皮肤水泡、神经麻痹和深静脉血栓形成。文献对于TKA手术是否应使用止血带存在分歧意见，在术后疼痛、失血和功能结局方面结果相互矛盾。
本研究纳入年龄在65至90岁之间因骨关节炎接受择期单侧TKA的患者。排除标准包括体重指数≥35的患者、类风湿关节炎患者、外周血管疾病患者、糖尿病患者、既往膝关节手术患者以及正在服用抗凝药物的患者。本研究重点通过神经传导研究比较使用和不使用止血带进行TKA的神经学情况以及功能结局。一些关键指标包括术中失血、手术时长、术后疼痛、镇痛药物使用以及活动范围（ROM）。
该研究招募了55名年龄在65至90岁之间的患者，这些患者被随机分为两组。22名患者被排除，最终分析涉及23名患者。与非止血带组相比，使用止血带导致失血量更低（140毫升对215毫升）以及手术时间更短（87分钟对95分钟）。然而，与另一组相比，止血带组在术后即刻神经麻痹的发生率更高。两组在术后ROM方面均有显著改善，但止血带组术后疼痛和镇痛需求更高，且具有统计学意义。
TKA中使用止血带可减少术中失血和手术时间，但与神经相关并发症风险增加以及术后疼痛加剧有关。研究结果表明，避免使用止血带可能会带来更好的总体临床结局和早期术后ROM。
