Tourniquets have traditionally been used in knee replacement to reduce blood loss during the procedure. A tourniquet is like a blood pressure cuff that is put around the upper thigh. It is inflated to relatively high pressures in order to compress the femoral artery during the operation. The timing of deflation varies by the surgeon, usually either before or after closure. If a standard blood pressure cuff on the arm is inflated to 180 mm Hg (a measure of pressure), total knee tourniquets are often inflated to 300-350mm Hg and kept there for 30-75 minutes. You can imagine the kind of pain this would cause.
Recent evidence and experience has pointed to potential adverse effects of tourniquet use. These are listed as follows:
1. Squeezing the large thigh muscles at high pressure for prolonged periods of time causes increased pain and muscle trauma. This can lead to significant thigh bruising and increased need for pain medications after surgery.
2. The same phenomenon causes inhibition of the quadriceps muscle which can slow the recovery of function after surgery.
3. Tourniquet deflation after closure of the knee replacement can cause the knee to fill up with blood causing painful swelling and limited range of motion.
4. Starving the leg of oxygen during the case can lead to tissue stress and the formation of free radicals which promote inflammation during the immediate period after tourniquet deflation. This can cause increased surgical stress. Reperfusion of the limb at the time of tourniquet deflation can lead to a rapid influx of these free radicals into the system.
5. Cessation of blood flow to the leg can promote a condition called stasis where the blood is not moving through the vessels. This can lead to a higher risk of blood clots after surgery.
In response to the desire to reduce pain and expedite function after surgery, our AVATAR program has been performing knee replacements without the tourniquet. While this results in a slight increase in blood loss during the surgery, it also allows the surgeon to control bleeding so that at the conclusion of the case there is limited additional bleeding. This leads to less overall swelling in the knee. Furthermore, because the thigh muscle is not traumatized by the cuff pressure, patients have less intraoperative and postoperative pain and earlier return of quadriceps muscle function. Continuous blood flow during the cases also prevents free radical formation and reduces the surgical stress response to these.
Our AVATAR program is committed to promoting the fasted recovery of comfort and function. In addition to customized surgery, advanced anesthetic and pain management techniques, immediate full range of motion and patient navigation through the surgical process, we lead the region in outpatient joint replacement. We are the only practice in the region offering the tourniquetless total knee with a quadriceps sparing surgical approach. Put our expertise, experience and advanced techniques to work for you if you require knee replacement surgery.
