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.