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Does Tourniquet Use Influence Patient-Reported Outcomes in Obese Patients Undergoing Primary Total Knee Arthroplasty?
Isaiah Freeman1, Muhammad Hamza Ilyas1, Carlo Mannina1
1Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Background:
Obese patients are at increased risk of complications after primary total knee arthroplasty (TKA). Tourniquets are commonly used intraoperatively to reduce bleeding and improve visualization, but their impact on patient-reported outcome measures (PROMs) in obese populations is not well understood. This study aimed to compare PROMs and complication rates after primary TKA in obese patients who did and did not have tourniquets using a propensity-matched analysis.
Methods:
A retrospective review identified 5,197 consecutive patients who underwent primary TKA at a single institution. Patients who had a body mass index > 30 and at least two years of follow-up were propensity-matched 1:3 based on age, sex, race, body mass index, and comorbidities. The 90-day, one-year, and two-year complication rates were recorded. The Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form, Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health-Physical, PROMIS Global Health-Mental, and PROMIS Physical Function Short Form 10a were extracted for both groups. Absolute scores, changes in (delta) scores, and minimal clinically important difference achievement were computed and compared. After matching, 281 patients in the no-tourniquet group and 843 patients in the tourniquet group were available for analysis.
Results:
Patients who had TKA without a tourniquet experienced complication rates comparable to those who received a tourniquet (P > 0.05). There were differences in absolute scores in multiple PROMs (P < 0.05), but similar delta scores and proportions of clinically meaningful improvement and worsening were present in both groups (P > 0.05).
Conclusions:
In obese patients undergoing primary TKA, tourniquet use was associated with no differences in 90-day or one- and two-year complication rates or clinically meaningful patient-perceived outcomes. These findings are consistent with prior studies in general TKA populations, which have shown that tourniquet use does not substantially affect complication or patient-reported satisfaction benefits.