Outcomes of Tourniquet-Less Revision Total Knee Arthroplasty: A Matched Cohort Analysis

A tourniquet is routinely used in total knee arthroplasty (TKA) to limit perioperative blood loss and increase the visibility of the surgeon's field of view. This study aims to evaluate the postoperative clinical outcomes and complications associated with tourniquet use in revision TKA.

We conducted a retrospective review of 1,904 consecutive patients who underwent revision TKA. Propensity score-based matching was done to adjust for baseline differences in patient demographics and procedure details.

Propensity score matching resulted in a cohort of 548 revision total joint arthroplasty patients, 274 (50.0%) of whom were tourniquet patients matched to 274 (50.0%) tourniquet-less patients. Multivariate regression analyses demonstrated that, compared with the tourniquet-less cohort, the tourniquet cohort had significantly less intraoperative (413.7 to 353.2 mL, P < 0.01) and total perioperative (1,548.7 to 1,417.8 mL, P < 0.01) blood loss. However, no significant differences were present in total perioperative (8.4%, 6.6%, P = 0.43) transfusion rates. The tourniquet cohort had increased length of stay (3.2 to 3.7 days, P < 0.001) and 30-day readmissions (P = 0.04).

This study demonstrated that although omitting the tourniquet in revision TKA leads to markedly increased perioperative blood loss, notable differences in perioperative transfusion rates were not observed. Furthermore, revision TKA without tourniquet use was associated with reduced postoperative length of stay, 30-day readmissions, and increased range of flexion.