Limb occlusion pressure versus standard tourniquet pressure in total: A prospective comparative study

Tourniquet use during total knee arthroplasty (TKA) facilitates a bloodless surgical field but is associated with postoperative complications such as thigh pain, skin changes, and functional delays. Determining optimal tourniquet pressure individualized to each patient is crucial to minimize these adverse effects. Limb occlusion pressure (LOP) provides a physiologic basis for personalized tourniquet pressure settings.

This prospective randomized study enrolled 60 patients undergoing primary TKA, randomized equally into two groups. Group A had tourniquet pressure set using automated LOP measurement plus a safety margin, while Group B used a fixed standard pressure of 300 mmHg. Primary outcomes included tourniquet-site pain (VAS), wound complications (Southampton score), and functional recovery (Oxford Knee Score) at 6 weeks. Secondary measures included intraoperative blood loss and safety events.

Group A had significantly lower tourniquet pressures (222.0 ± 28.6 mmHg vs. 300 mmHg, p < 0.001) without increased blood loss (744.2 ± 256.4 ml vs. 709.8 ± 283.7 ml, p = 0.458). Postoperative pain was notably reduced in Group A, with 60 % scoring ≤2 on VAS compared to 20 % in Group B (p = 0.015). Wound healing was superior in Group A (60 % perfect healing vs. 20 %, p = 0.002), with fewer incidences of erythema, blistering, and bruising. Functional outcomes were better in Group A (Oxford Knee Score 35.9 ± 3.0 vs. 32.6 ± 1.7, p < 0.001). No significant neurovascular or thromboembolic complications were reported.

LOP-guided individualized tourniquet pressure in TKA significantly reduces postoperative pain and wound complications while maintaining an effective bloodless field and comparable blood loss. Personalized pressure settings enhance early functional recovery and patient comfort, supporting routine LOP use for tourniquet management in orthopedic surgery.