Complications Following Aseptic Knee Revision Based on Tourniquet Use

Tourniquet use in revision total knee arthroplasty (rTKA) enhances visualization and improves cement penetration. However, concerns exist about muscle injury, pain, wound complications, and venous thromboembolism (VTE). This retrospective matched cohort study compared clinical outcomes in aseptic rTKA performed with no/minimal tourniquet use vs standard tourniquet use.

One hundred rTKAs performed with no/minimal tourniquet use were matched to 100 rTKAs performed with standard tourniquet use (P ≥ .242). The impact of tourniquet use and 4 additional covariates on outcomes were compared with Pearson's chi-square tests, Student's t-tests, and the Pearson correlation coefficient (r) using α ≤ 0.05. When multiple covariates were significant, the General Linear Model was used to identify whether tourniquet use remained significant.

Mean estimated blood loss and blood transfusion did not differ between groups. There were no major inpatient events or differences in 90-day VTE, wound complications, or reoperations. Opioid requests were higher in the standard tourniquet group. Mean opioid use in the first 24 hours was higher in the standard group despite similar pain scores. After 24 hours, mean opioid use and mean pain were significantly lower in the standard group. Mean final pain scores were similar.

In aseptic rTKA, use of tourniquets may not affect blood loss, complications, wound complications, VTE, and reoperation, although the low incidence of some events may have prevented detection of statistically significant differences. Differences in postoperative pain and opioid use deserve further exploration. Tourniquet decisions based on individual patient and surgical factors may remain the best approach.