The use of tourniquets in total knee arthroplasty (TKA) for patients with knee osteoarthritis is controversial. Although surgical techniques are more easily applied in a shorter time; there are some disadvantages associated with tourniquet use in orthopedic surgery. The aim of this study was to evaluate the effect of the tourniquet time on quadriceps strength by isokinetic muscle strength measurements in patients undergoing TKA. Prospective controlled study. Twenty-five knees of 25 patients with primary degenerative joint disease who underwent TKA were evaluated preoperatively and postoperatively at weeks 6 and 12 and month 6 by isokinetic knee extensor muscle strength testing at and American Knee Society Score (AKSS). The tourniquet time of all patients was recorded, and the preoperative results of all patients were compared with those postoperatively. The mean 60º/s angular velocity quadriceps peak torque was significantly lower postoperatively in patients with a longer tourniquet time. Isokinetic tests showed a significant negative correlation between the tourniquet time and mean muscle strength (week 6: r = –0.718, p < 0.01; week 12: r = –0.651, p < 0.01; month 6: r = –0.672, p < 0.01). The highest correlation with tourniquet time was obtained 6 weeks after surgery. Additionally, strong negative correlations were observed between the AKSS and tourniquet times (Knee Score: r = –0.904, p < 0.01; Knee Functional Score: r = –0.878, p < 0.01). Lower postoperative mean quadriceps strength in patients with a longer tourniquet time, suggesting that the tourniquet time affects the quadriceps muscle strength witl longer times resulting lower muscle strength
1. Wakankar HM, Nicholl JE, Koka R, D’Arcy JC. The tourniquet in total knee arthroplasty A prospective randomised study. J Bone Joint Surg Br. 1999;81(1):30-3.
2. Abdel-Salam A, Eyres KS. Effects of tourniquet during total knee arthroplasty. A prospective randomised study. J Bone Joint Surg Br. 1995;77(2):250-3.
3. Noordin S, McEwen JA, Kragh JF Jr, Eisen A, Masri BA. Surgical tourniquets in orthopaedics. J Bone Joint Surg Am. 2009;91(12):2958-67.
4. Berman AT, Bosacco SJ, Israelite C. Evaluation of total knee arthroplasty using isokinetic testing. Clin Orthop Relat Res. 1991;271:106-13.
5. Aquino M, Leme LE. Isokinetic dynamometry in elderly women undergoing total knee arthroplasty: a comparative study. Clinics (Sao Paulo). 2006;61(3):215-22.
6. Jaric S. Muscle strength testing: use of normalisation for body size. Sports Med. 2002;32(10):615-31.
7. Tetro AM, Rudan JF. The effects of a pneumatic tourniquet on blood loss in total knee arthroplasty. Can J Surg. 2001;44(1):33-8.
8. Fukuda A, Hasegawa M, Kato K, Shi D, Sudo A, Uchida A. Effect of tourniquet application on deep vein thrombosis after total knee arthroplasty. Arch Orthop Trauma Surg. 2007;127(8): 671-5.
9. Aglietti P, Baldini A, Vena LM, Abbate R, Fedi S, Falclani M. Effect of tourniquet use on activation of coagulation in total knee replacement. Clin Orthop Relat Res. 2000;371:169-77.
10. Harvey EJ, Leclerc J, Brooks CE, Burke DL. Effect of tourniquet use of blood loss and incidence of deep vein thrombosis in total knee arthroplasty. J Arthroplasty. 1997;12(3):291–6.
11. Klenerman L. Is a tourniquet really necessary for total knee replacement. J Bone Joint Surg Br. 1995;77(2):174-5.
12. Pedowitz RA. Tourniquet-induced neuromuscular injury. A recent review of rabbit and clinical experiments. Acta Orthop Scand. 1991;245:1-33.
13. Shaw JA, Murray DG. The relationship between tourniquet pressure and the underlying soft-tissue pressure in the thigh. J Bone Joint Surgery (Am). 1982;64(8):1148-52.
14. Saunders KC, Louis DL, Weingarden SL, Waylonis GW. Effect of tourniquet time on post-operative quadriceps function. Clinical Orthop. 1979;143:194-9.
15. Palmer SH, Graham G. Tourniquet-induced rhabdomyolysis after total knee replacement. Ann R Coll Surg Engl. 1994;76(6):416-7.
16. McGrath BJ, Hsia J, Epstein B. Massive pulmonary embolism following tourniquet deflation. Anaesthesiology. 1991;74(3): 618-20.
17. Loennechen JP, Stoylen A, Beisvag V, Wisloff U, Ellingsen O. Regional expression of endothelin-1, ANP, IGF-1, and LV wall stress in the infarcted rat heart. Am J Physiol Heart Circ Physiol. 2001;280(6):2902-10.
18. Kakizawa H, Itoh M, Itoh Y, Imamura S, Ishiwata Y, Matsumoto T, Yamamoto K, Kato T, Ono Y, Nagata M, Hayakawa N, Suzuki A, Goto Y, Oda N. The relationship between glycemic control and plasma vascular endothelial growth factor and endothelin-1 concentration in diabetic patients. Metabolism. 2004;53(5):550-5.
19. Kiss H, Raffl M, Neumann D, Hutter J, Dorn U. Epinephrineaugmented hypotensive epidural anaesthesia replaces tourniquet use in total knee replacement. Clin Orthop Relat Res. 2005;436:184-9.
20. Nishiguchi M, Takamura N, Abe Y, Kono M, Shindo H, Aoyagi K. Pilot study on the use of tourniquet: a risk factor for pulmonary thromboembolism after total knee arthroplasty? Thrombosis Res. 2005;115(4):271-6.
21. Cila E, Güzel V, Ozalay M, Tan J, Simşek SA, Kanatli U, Oztürk A. Subvastus versus medial parapatellar approach in total knee arthroplasty. Arch Orthop Trauma Surg. 2002;122:65-8.
22. Silva M, Shepherd EF, Jackson WO, Pratt JA, McClung CD, Schmalzried TP. Knee strength after total knee arthroplasty. J Arthroplasty. 2003;18(5):605-11.
23. Lialiaris T, Kouskoukis A, Tiaka E, Digkas E, Beletsiotis A, Vlasis K, Papathanasiou E, Athanassiou E, Natsis K. Cytogenetic damage after ischemia and reperfusion. Genet Test Mol Biomarkers. 2010;14(4):471-5.
24. Hammers DW, Matheny RW Jr, Sell C, Adamo ML, Walters TJ, Estep JS, Estep JS, Farrar RP. Impairment of IGF-I expression and anabolic signaling following ischemia/reperfusion in skeletal muscle of old mice. Exp Gerontol. 2011;46(4):265-72.
25. Patterson S, Klenerman L. The effect of pneumatic tourniquet on the ultrastructure of skeletal muscle. J Bone Joint Surg Br. 1979;61- B(2):178-83.
26. Tran TP, Tu H, Pipinos II, Muelleman RL, Albadawi H, Li YL. Tourniquet-induced acute ischemia-reperfusion injury in mouse skeletal muscles: Involvement of superoxide. Eur J Pharmacol. 2011;650(1):328-34.
27. Palmer SH, Graham G. Tourniquet-induced rhabdomyolysis after total knee replacement. Ann R Coll Surg Engl. 1994;76(6):416-7.