Elsevier

The Journal of Arthroplasty

Volume 12, Issue 8, December 1997, Pages 848-852
The Journal of Arthroplasty

Original article
Thigh pain following tourniquet application in simultaneous bilateral total knee replacement arthroplasty

https://doi.org/10.1016/S0883-5403(97)90153-4Get rights and content

Abstract

Thigh pain following tourniquet application is a common patient complaint in the early postoperative period following total knee arthroplasty. Postoperative thigh pain was evaluated in 28 consecutive simultaneous bilateral total knee arthroplasty patients between April 1996 and October 1996. A prospective, doubleblind, randomized clinical trial was performed. Tourniquet pressure of 350 mmHg was used on 1 thigh (thigh 1) and 100 mmHg plus systolic blood pressure on the other (thigh 2). A scale of pain (no pain, mild, moderate, or severe) was applied on the first, second, and third days, as well as 2 and 6 weeks after surgery. There were 16 men and 12 women with a mean age of 72 years (range, 55–85 years). The mean tourniquet time was similar in both groups (thigh 1 = 23 minutes, thigh 2 = 22 minutes). The mean tourniquet pressure in thigh 2 was 230 mmHg (range, 212–260 mmHg). There was a statistically significant difference in thigh pain on the first (P = .01), second (P = .01), and third (P = .001) postoperative days between both groups, with more thigh pain on the 350 mmHg side. At 6 weeks after surgery, the difference in thigh pain was gone. For total knee arthroplasty, using the tourniquet at a pressure of 100 mmHg above the systolic blood pressure is recommended. This is adequate to provide a bloodless field and will result in a less unpleasant postoperative period.

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      This result is consistent with the study of Worland et al., who compared high tourniquet pressure (350 mm Hg) vs low tourniquet pressure (SBP + 100 mm Hg, mean 230 mm Hg) in simultaneous bilateral TKA. They found that the high tourniquet pressure group had more thigh pain on postoperative days 1-3 but not at 6 weeks compared to the low tourniquet pressure group [24]. Postoperative limb swelling measured in our study showed no difference in all 3 groups, and our results concur with those of Alexandersson et al [25] who randomly compared tourniquet vs no tourniquet in TKA and found no differences in knee swelling on the first and third postoperative days and at 12 weeks.

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      In our day, intensive effort is put to reduce bleeding with minimum side effects in TKA surgery. Although the widely used tourniquet application reduces the perioperative hemorrhage, it causes increased postoperative and total blood loss, venous thromboembolic problems, and bad functional knee scores in the early period [15,16]. On the other hand, antifibrinolytic agents such as tranexamic acid (TXA), which are becoming more widely used, reduce blood loss and avoid tourniquet-induced morbidities [17].

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