Effects of Surgical Approach and Tourniquet Use on Patient-Reported Outcomes Following Total Knee Arthroplasty: A Pilot Randomized Clinical Trial
Olawale A Sogbein,1,2 Bryn O Zomar,1,3 Dianne M Bryant,3 James L Howard,1 Jacquelyn D Marsh,1 Brent A Lanting1 1London Health Sciences Centre – University Hospital, Division of Orthopaedic Surgery, Department of Surgery, London, Ontario, Canada; 2Schulich School of Medicine & Dentistry, Western...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2022-11-01
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| Series: | Orthopedic Research and Reviews |
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| Online Access: | https://www.dovepress.com/effects-of-surgical-approach-and-tourniquet-use-on-patient-reported-ou-peer-reviewed-fulltext-article-ORR |
| _version_ | 1798018279474724864 |
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| author | Sogbein OA Zomar BO Bryant DM Howard JL Marsh JD Lanting BA |
| author_facet | Sogbein OA Zomar BO Bryant DM Howard JL Marsh JD Lanting BA |
| author_sort | Sogbein OA |
| collection | DOAJ |
| description | Olawale A Sogbein,1,2 Bryn O Zomar,1,3 Dianne M Bryant,3 James L Howard,1 Jacquelyn D Marsh,1 Brent A Lanting1 1London Health Sciences Centre – University Hospital, Division of Orthopaedic Surgery, Department of Surgery, London, Ontario, Canada; 2Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; 3Faculty of Health and Rehabilitation Sciences, Western University, London, Ontario, CanadaCorrespondence: Olawale A Sogbein, Tel +1 519-476-1151, Email olsogbein@nosm.caIntroduction: Total knee arthroplasty (TKA) is one of the most successful procedures for the treatment of severe knee osteoarthritis. Various surgical approaches have been investigated in the hopes of improving postoperative outcomes. Two include the medial parapatellar (standard) and midvastus. As the midvastus approach does not disrupt the extensor mechanism, it may be advantageous for functional recovery, however length of stay and long-term function are similar between approaches. Tourniquet use during TKA has conflicting results in the literature. We hypothesized that a future trial comparing outpatient versus standard TKA could appropriately use either surgical approach with or without a tourniquet. Therefore, the objective of this pilot randomized trial was to compare postoperative pain, function, quality of life, and satisfaction between patients who underwent a medial parapatellar or midvastus approach for TKA ± tourniquet use.Methods: We conducted a randomized trial with a two-by-two factorial design to compare the medial parapatellar to the midvastus surgical approach for TKA ± tourniquet use. The Short Form-12 (SF-12), Western Ontario McMaster Osteoarthritis Index (WOMAC), and Knee Society Score (KSS) were collected at baseline, postoperatively at two, six, 12 weeks, and one year.Results: Eighty-three patients were included. Postoperative WOMAC scores were statistically but not clinically higher at six weeks and three months in favour of no tourniquet use. There were no differences in postoperative WOMAC scores between approaches. Short Form-12 and KSS scores increased in both groups with no significant differences postoperatively (p > 0.05).Conclusion: There were no clinically significant differences in postoperative pain, function, quality of life, or satisfaction between surgical approaches or whether a tourniquet was used. As such, both surgical approaches ± tourniquet use are safe and reliable. We believe a future larger randomized trial could likely incorporate either surgical approach or tourniquet preferences without significant impact on patient reported outcomes.Keywords: total knee arthroplasty, midvastus, medial parapatellar, tourniquet |
| first_indexed | 2024-04-11T16:21:28Z |
| format | Article |
| id | doaj.art-b866a835ebe9459194d4963f0b85264a |
| institution | Directory Open Access Journal |
| issn | 1179-1462 |
| language | English |
| last_indexed | 2024-04-11T16:21:28Z |
| publishDate | 2022-11-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Orthopedic Research and Reviews |
| spelling | doaj.art-b866a835ebe9459194d4963f0b85264a2022-12-22T04:14:20ZengDove Medical PressOrthopedic Research and Reviews1179-14622022-11-01Volume 1440741779684Effects of Surgical Approach and Tourniquet Use on Patient-Reported Outcomes Following Total Knee Arthroplasty: A Pilot Randomized Clinical TrialSogbein OAZomar BOBryant DMHoward JLMarsh JDLanting BAOlawale A Sogbein,1,2 Bryn O Zomar,1,3 Dianne M Bryant,3 James L Howard,1 Jacquelyn D Marsh,1 Brent A Lanting1 1London Health Sciences Centre – University Hospital, Division of Orthopaedic Surgery, Department of Surgery, London, Ontario, Canada; 2Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; 3Faculty of Health and Rehabilitation Sciences, Western University, London, Ontario, CanadaCorrespondence: Olawale A Sogbein, Tel +1 519-476-1151, Email olsogbein@nosm.caIntroduction: Total knee arthroplasty (TKA) is one of the most successful procedures for the treatment of severe knee osteoarthritis. Various surgical approaches have been investigated in the hopes of improving postoperative outcomes. Two include the medial parapatellar (standard) and midvastus. As the midvastus approach does not disrupt the extensor mechanism, it may be advantageous for functional recovery, however length of stay and long-term function are similar between approaches. Tourniquet use during TKA has conflicting results in the literature. We hypothesized that a future trial comparing outpatient versus standard TKA could appropriately use either surgical approach with or without a tourniquet. Therefore, the objective of this pilot randomized trial was to compare postoperative pain, function, quality of life, and satisfaction between patients who underwent a medial parapatellar or midvastus approach for TKA ± tourniquet use.Methods: We conducted a randomized trial with a two-by-two factorial design to compare the medial parapatellar to the midvastus surgical approach for TKA ± tourniquet use. The Short Form-12 (SF-12), Western Ontario McMaster Osteoarthritis Index (WOMAC), and Knee Society Score (KSS) were collected at baseline, postoperatively at two, six, 12 weeks, and one year.Results: Eighty-three patients were included. Postoperative WOMAC scores were statistically but not clinically higher at six weeks and three months in favour of no tourniquet use. There were no differences in postoperative WOMAC scores between approaches. Short Form-12 and KSS scores increased in both groups with no significant differences postoperatively (p > 0.05).Conclusion: There were no clinically significant differences in postoperative pain, function, quality of life, or satisfaction between surgical approaches or whether a tourniquet was used. As such, both surgical approaches ± tourniquet use are safe and reliable. We believe a future larger randomized trial could likely incorporate either surgical approach or tourniquet preferences without significant impact on patient reported outcomes.Keywords: total knee arthroplasty, midvastus, medial parapatellar, tourniquethttps://www.dovepress.com/effects-of-surgical-approach-and-tourniquet-use-on-patient-reported-ou-peer-reviewed-fulltext-article-ORRtotal knee arthroplastymidvastusmedial parapatellartourniquet |
| spellingShingle | Sogbein OA Zomar BO Bryant DM Howard JL Marsh JD Lanting BA Effects of Surgical Approach and Tourniquet Use on Patient-Reported Outcomes Following Total Knee Arthroplasty: A Pilot Randomized Clinical Trial Orthopedic Research and Reviews total knee arthroplasty midvastus medial parapatellar tourniquet |
| title | Effects of Surgical Approach and Tourniquet Use on Patient-Reported Outcomes Following Total Knee Arthroplasty: A Pilot Randomized Clinical Trial |
| title_full | Effects of Surgical Approach and Tourniquet Use on Patient-Reported Outcomes Following Total Knee Arthroplasty: A Pilot Randomized Clinical Trial |
| title_fullStr | Effects of Surgical Approach and Tourniquet Use on Patient-Reported Outcomes Following Total Knee Arthroplasty: A Pilot Randomized Clinical Trial |
| title_full_unstemmed | Effects of Surgical Approach and Tourniquet Use on Patient-Reported Outcomes Following Total Knee Arthroplasty: A Pilot Randomized Clinical Trial |
| title_short | Effects of Surgical Approach and Tourniquet Use on Patient-Reported Outcomes Following Total Knee Arthroplasty: A Pilot Randomized Clinical Trial |
| title_sort | effects of surgical approach and tourniquet use on patient reported outcomes following total knee arthroplasty a pilot randomized clinical trial |
| topic | total knee arthroplasty midvastus medial parapatellar tourniquet |
| url | https://www.dovepress.com/effects-of-surgical-approach-and-tourniquet-use-on-patient-reported-ou-peer-reviewed-fulltext-article-ORR |
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