Orthopedic Services

Tourniquet-Less Knee Replacement Surgery Technique

Tourniquet-Less Knee Replacement

Traditionally, a tourniquet is used during surgery to create a bloodless surgical area and reduce intraoperative bleeding, which can reduce surgical time.

There are adverse side effects to using a tourniquet that many people do not know about, including an increase in pain. As a patient, it is important to understand your surgical plan and ask questions.

The risks of using a tourniquet during knee replacement surgery

Increased pain.
Nerve damage.
Ischemia (a shortage of blood and oxygen to the heart).
Soft tissue damage.
Blood clot.
Poor wound healing.
Longer recovery.
Temporary reduction in muscle strength.
Reduced range of motion in knee.

Many of the potential side effects of a tourniquet arise post-operatively during recovery. During knee replacement surgery, some surgeons only use a tourniquet for a brief period to control the bleeding during surgery.

As the tourniquet is not used the entire time, patients often see a reduction in swelling and bleeding around the surgical site, as well as the following benefits:

Reduced pain.
Quicker recovery.
Ability to begin physical therapy and rehabilitation quicker.
Shorter hospital stay.
Up and walking same day as surgery.

Published studies in which tourniquet use was compared to no tourniquet use showed a marked reduction in pain and opioid use, better KOOS scores and range of motion, and improved VAS for pain and timed up and go test scores for the no tourniquet group, according to Rodriguez.

Related article: Faster recovery without the use of a tourniquet in total knee arthroplasty.

A randomized study of 70 patients.
Background and purpose
Tourniquet application is still a common practice in total knee arthroplasty (TKA) surgery despite being associated with several adverse effects. We evaluated the effects of tourniquet use on functional and clinical outcome and on knee range of motion (ROM).

Patients and methods
70 patients who underwent TKA were randomized into a tourniquet group (n = 35) and a non-tourniquet group (n = 35). All operations were performed by the same surgeon and follow-up was for 1 year. Primary outcomes were functional and clinical outcomes, as evaluated by KOOS and knee ROM. Secondary outcomes were intraoperative blood loss, surgical time and visibility, postoperative pain, analgesic consumption, and transfusion requirements.

Results
Patients in the non-tourniquet group showed a better outcome in all KOOS subscores and better early knee ROM from surgery to week 8. No difference was detected at the 6- and 12-month follow-ups. Postoperative pain and analgesic consumption were less when a tourniquet was not used. Surgical time and visibility were similar between groups. Intraoperative blood loss was greater when not using a tourniquet, but no postoperative transfusions were required.

Interpretation
This study shows that TKA without the use of a tourniquet results in faster recovery in terms of better functional outcome and improved knee ROM. Furthermore, reduced pain and analgesic use were registered and no intraoperative difficulties were encountered.

Related study and article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4105775/

What is a Tourniquet?

A tourniquet is a device which applies pressure to a limb or extremity so as to limit – but not stop – the flow of blood. It may be used in emergencies, in surgery, or in post-operative rehabilitation. A simple tourniquet can be made from a stick and a rope (or leather belt).
The rope is made into a loop that fits over the damaged limb, and the stick is inserted through the loop. The loop is tightened by twisting the stick. This may stem the flow of blood, but side-effects such as soft tissue damage and nerve damage may occur. The use of a tourniquet during total knee replacement surgery is quite common. However, many patients don’t know or fully understand the risks of using a tourniquet during surgery. Wikipedia

About Knee Replacement Surgery Options

Stryker® Mako™ Robotic-Arm Assisted Total Knee Replacement

Stryker® Mako™ Robotic-Arm Assisted Partial Knee Replacement

Traditional Knee Replacement

Non-Muscle Cutting Knee Replacement

Tourniquet-Less Knee Replacement

Dr. Ronald Hudanich is a board-certified orthopedic surgeon and has a long history of successfully treating patients with knee, hip, and shoulder degenerations and joint replacement surgeries. Dr. Hudanich is specially trained to restore your range of motion, ease the pain, and enable you to regain your active lifestyle with a partial, total or revised joint replacement surgical option that is best for you.

For additional questions please call us at (407) 977-4130 or visit American Academy of Orthopaedic Surgeons.