Impact of Tourniquet on Blood Loss and Postoperative Recovery in Total Knee Arthroplasty: A Randomized Clinical Trial

Background: Total knee arthroplasty (TKA) is an effective surgical procedure for alleviating pain and improving function in patients with severe knee osteoarthritis. However, significant intraoperative blood loss is a common concern, often necessitating blood transfusions and increasing the risk of complications. A tourniquet during TKA is a widely accepted technique to reduce blood loss and improve implant fixation, but it may lead to postoperative pain and restricted range of motion (ROM).  Objectives: This randomized clinical trial aimed to compare intraoperative blood loss, postoperative ROM, and pain in patients undergoing TKA with and without a tourniquet. Methods: A total of 34 patients were randomized into two groups: 18 patients in the tourniquet group (TG) and 16 in the non-tourniquet group (NTG). Intraoperative blood loss, postoperative hemoglobin levels, ROM, thigh pain, and straight leg raise (SLR) were measured at multiple intervals postoperatively.  Results: The results showed that the TG group had significantly lower intraoperative blood loss (236.11 mL vs 531.25 mL, P 0.001) and higher postoperative hemoglobin levels than the NTG group. However, the TG group experienced significantly lower ROM on the first and second postoperative days (P 0.001) and reported greater thigh pain. By six months postoperatively, the two groups had no significant difference in ROM. Conclusion: Using a tourniquet in TKA significantly reduces intraoperative blood loss but is associated with increased immediate postoperative pain and reduced early ROM. However, these adverse effects do not persist long-term. Individualized patient care and strategies to optimize tourniquet use are recommended to balance these outcomes.