Brawly Taylor, BS
MS4
University of Nebraska Medical Center
Omaha, Nebraska, United States
Bradford Zitsch, MD
Orthopedic Resident
University of Nebraska Medical Center
Omaha, Nebraska, United States
Matthew Tao, MD
Associate Professor, Orthopedic Surgery
University of Nebraska Medical Center
Omaha, Nebraska, United States
Curtis Hartman, MD
Professor, Orthopedic Surgery
University of Nebraska Medical Center
Omaha, Nebraska, United States
Elizabeth Wellstandt, PT, DPT, PhD, OCS
Associate Professor of Physical Therapy
University of Nebraska Medical Center
Omaha, Nebraska, United States
Elizabeth Leyden, MS
Instructor, Biostatistics
University of Nebraska Medical Center
Omaha, Nebraska, United States
Pneumatic thigh-high tourniquet in Total Knee Arthroplasty (TKA) improves surgical visibility but is linked to increased post-operative pain and decreased muscle strength. This may lead to altered gait and delayed rehabilitation. The study evaluates the impact of tourniquet use on post-operative gait in primary TKA.
Design:
In a prospective, randomized clinical trial, patients undergoing primary TKA were assigned to either a pneumatic thigh-high tourniquet or no tourniquet. Of 73 enrolled, 71 patients completed the study (33 no tourniquet; 38 tourniquet). Demographics and surgical characteristics were compared. Gait parameters were assessed preoperatively and six weeks postoperatively using an instrumented pressure walkway. Comparisons were made within and between groups and statistical significance was set at p < 0.05.
Results:
Patient demographics were similar between groups. The mean tourniquet time was 67.4 ± 19.6 minutes. Mean intraoperative blood loss was higher in the tourniquetless group as compared to the tourniquet group (157.6 ± 87.6 mL versus 59.7 ± 28.1 mL) (p< 0.0001). Surgical time was higher in the tourniquet group (97.9 ± 19.0 minutes) as compared to the tourniquetless group (87 ± 17.4) (p=0.04). For all included patients, spatiotemporal gait parameters were similar between the pre and postoperative assessments with a mean stride length increase of 1.4 ± 18.0 cm (p =0.52), stride width increase of 0.31 ± 4.1 (p =0.52), and decreases in both ipsilateral single-leg support percentage and total double support percentage of 0.14 ± 4.2 (p=0.78) and 0.54 ± 4.0 (p=0.26), respectively. There were no statistically significant differences in the change in gait measures between the two groups.
Conclusions:
Spatiotemporal gait parameters return to preoperative baseline levels by six-weeks post-TKA, regardless of tourniquet use, with no significant differences between the two groups. Future studies should consider earlier evaluation of gait for a more detailed comparison.
