Influência do uso do torniquete no controle do sangramento, dor, força do músculo quadríceps e recuperação funcional em artroplastias totais de joelho: estudo clínico randomizado

Abstract

BACKGROUND: Total knee arthroplasty (TKA) is a surgical intervention for moderate to advanced knee osteoarthritis (OA). However, consensus is lacking regarding certain techniques in this procedure, such as the use of a tourniquet during surgery. Considering this as a widely performed surgery, optimizing patient care for this procedure is essential. OBJECTIVES: General: To evaluate the impact of tourniquet use on bleeding control, pain, quadriceps muscle strength, and functional knee recovery in TKA. Specific: To establish the epidemiological profile; correlate variables such as bleeding, pain, and quadriceps strength during pre- and immediate postoperative periods; and assess quality of life and functional recovery of the knee in patients undergoing TKA with and without the use of a tourniquet. METHOD: This is a double-blind, randomized controlled, quantitative (analytical) primary experimental clinical study to evaluate the influence of tourniquet usage in total knee arthroplasty. Data were collected through pre- and postoperative hemoglobin levels, application of epidemiological questionnaires, quality of life and functional capacity assessments (SF-36, KOOS, and Lequesne), pain scales (EVA) and muscle strength levels (MRC) in patients with indication for TKA performed at a university hospital. RESULTS: Forty-three patients underwent surgery, 22 with the use of a tourniquet and 21 without it. The epidemiological profile revealed elderly, retired, obese women of brown ethnicity, married, with incomplete elementary education, predominantly residing in the state capital. Patients who underwent surgery with a tourniquet experienced less bleeding (p < 0.0001) but reported more pain (p 0.0413) in the early postoperative period. No significant differences were observed between the groups regarding quadriceps muscle strength (p 0.2301), quality of life (p 0.2094 and 0.2094), or functional capacity (p 0.2134). CONCLUSIONS: The use of a tourniquet in TKA resulted in reduced bleeding compared to surgeries without a tourniquet. However, it was associated with increased pain in the early postoperative period. Muscle strength, quality of life, and functional capacity showed no significant differences between groups.