Tourniquet Use Increases Transfusion Risk, LOS in TKA Patients

The use of a tourniquet in routine primary total knee arthroplasty (TKA) may put patients at a higher risk of transfusion and longer postoperative length of stay (LOS), according to a study.

Tourniquet use remains a subject of debate in primary TKAs. “Proponents of tourniquet use in TKA believe that it can reduce intraoperative bleeding volume (which potentially offers a relatively bloodless operating field), decreases the operative time, and, perhaps most importantly, ensures a better cementation result that leads to effective and long-term implant fixation,” explained the authors of the present study. “However, opponents of tourniquets propose that their use in TKA can lead to skin blistering, soft-tissue damage, muscle atrophy, ischemia–reperfusion injury (which contributes to postoperative pain), hematoma at the thigh, and weakness of the quadriceps; moreover, tourniquet use can hamper early mobilization and slow down postoperative rehabilitation.”

This study cohort encompassed 6,325 primary unilateral TKA patients who were stratified into two groups based on whether a tourniquet was (n=4,902) or was not (n=1,423) used during surgery. The primary outcomes were transfusion and LOS, which were determined using the patients’ electronic health records. The mean age of the entire cohort was 66.60 ± 8.75 years, and 4,971 (78.59%) patients were female. Most patients (n=5,924; 93.66%) were undergoing surgery due to osteoarthritis, with the remaining patients being treated for inflammatory arthritis. The tourniquet group had a higher rate of comorbidities (30.25% vs. 15.74%), the most prevalent of which was type 2 diabetes.

The transfusion rate in the tourniquet group was 14.52%, compared to 6.47% when one was not used; postoperative LOS was 7.72 ± 3.54 days and 6.44 ± 3.48 days, respectively. In adjusted analyses, tourniquet use significantly increased the risk for transfusion (risk ratio=1.888; 95% confidence interval [CI], 1.449 to 2.461; P<0.001) and was associated with longer postoperative LOS (partial regression coefficient [B]=0.923; 95% CI, 0.690 to 1.156; P<0.001).

The study was published in BMC Musculoskeletal Disorders.

“Our findings suggested that tourniquet use in routine primary TKA was related to a higher transfusion rate and a longer [postoperative LOS]. The impact of tourniquet use on transfusion rate and PLOS should be taken into account in clinical practice,” the researchers concluded.