title: Tourniquet versus no tourniquet on knee-extension strength early after fast-track total knee arthroplasty; a randomized controlled trial.
abstract: BACKGROUND
  Thigh tourniquet is commonly used in total knee arthroplasty (TKA) but may contribute to pain and muscle damage. Consequently, the reduction in knee-extension strength after TKA may be caused by quadriceps muscle ischaemia underneath the cuff.
  
  
  OBJECTIVE
  To examine if not using a thigh tourniquet during surgery was more effective than using a thigh tourniquet in preserving knee-extension strength 48 h after fast-track TKA.
  
  
  METHODS
  A total of 64 patients undergoing TKA were randomized (1:1) to the use of tourniquet (T-group) or no tourniquet (NT-group). In the T-group the tourniquet cuff pressure was based on the patient's systolic pressure and a margin of 100 mm Hg. It was inflated immediately before surgery and deflated as soon as surgery ended. The primary outcome was the change in knee-extension strength from pre-surgery to 48 h after surgery (primary end point). Secondary outcomes were pain, nausea, length of hospital stay (LOS) and periarticular swelling.
  
  
  RESULTS
  Knee-extension strength 48 h after surgery was substantially reduced by about 90% in both groups, with no statistically significant difference between groups (mean difference 1.5 N/kg, 95% CI 1.3-1.6). Among the secondary outcomes, the T-group had less bleeding during surgery (56 vs. 182 mL, P<0.01) compared with the NT-group. There was no difference in postoperative haemoglobin levels, pain, nausea, LOS or periarticular swelling between the groups.
  
  
  CONCLUSIONS
  Not using a thigh tourniquet during surgery was not superior in preserving knee-extension strength at the primary endpoint 48 h after fast-track TKA, compared to using a tourniquet.
authors: Dept of Anesthesiology, Hässleholm Hospital and Lund University, Box 351, 281 25 Hässleholm, Sweden. Electronic address: andreas.harsten@skane.se.
authors: Andreas
authors: A
authors: Harsten
authors: Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Dept of Physical Therapy, Denmark; Dept of Orthopedic Surgery, Hvidovre Hospital, University of Copenhagen, Denmark; Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Denmark.
authors: Thomas
authors: T
authors: Bandholm
authors: Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Denmark; Dept of Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Blegdamsvej 9, DK-2100, Denmark.
authors: Henrik
authors: H
authors: Kehlet
authors: Dept of Orthopedic Surgery, Hässleholm Hospital and Lund University, Box 351, 281 25 Hässleholm, Sweden.
authors: Sören
authors: S
authors: Toksvig-Larsen
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery; D010149:Postoperative Pain / Q000188:drug therapy; D017060:Patient Satisfaction; D052097:Quadriceps Muscle / Q000502:physiology*; D020127:Recovery of Function; D014111:Tourniquets; D016896:Treatment Outcome
keywords: Complication; Quadriceps muscle function; Total knee arthroplasty; Tourniquet