{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T15:49:07Z","timestamp":1761061747675,"version":"build-2065373602"},"reference-count":32,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,11,28]],"date-time":"2022-11-28T00:00:00Z","timestamp":1669593600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,11,28]],"date-time":"2022-11-28T00:00:00Z","timestamp":1669593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2022,11,28]],"date-time":"2022-11-28T00:00:00Z","timestamp":1669593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>This prospective randomized controlled trial aimed to determine whether the limited use of tourniquets during total knee arthroplasty (TKA) would be more beneficial under the contemporary enhanced recovery after surgery (ERAS) protocol than the conventional use of tourniquets.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>One hundred patients with knee osteoarthritis who underwent primary TKA were randomly assigned to the limited tourniquet (LT, <jats:italic>n<\/jats:italic>\u2009=\u200951) and conventional tourniquet (CT, <jats:italic>n<\/jats:italic>\u2009=\u200949) groups. Operation time, serial hemoglobin drops, calculated blood loss, transfusion rate, D\u2010dimer levels, and the presence of deep vein thrombosis (DVT) were assessed. In addition, visual analog scale (VAS) scores for pain around the knee and thigh were measured while resting during the day, at night, and during ambulation. Opioid consumption, range of motion, knee circumference, and postoperative complications were also analyzed. Isokinetic muscle strength, knee injury and osteoarthritis outcome scores, and Euro\u2010QoL\u20105D scores were also assessed before and 3\u00a0months after TKA. For statistical analysis, Chi\u2010square and Fisher\u2019s exact tests were performed to compare the differences in categorical variables. Continuous variables were compared using an independent <jats:italic>t<\/jats:italic> test or Mann\u2012Whitney <jats:italic>U<\/jats:italic> test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The average tourniquet time was 46.7\u00a0min in the CT group and 5.4\u00a0min in the LT group. Knee pain on the first night after surgery was significantly higher in the CT group (3.2 vs. 4.6, <jats:italic>p<\/jats:italic>\u2009=\u20090.033). However, daytime pain in the thigh at 2 weeks and in the knee at 3\u00a0months after TKA were higher in the LT group than in the CT group (<jats:italic>p<\/jats:italic>\u2009=\u20090.048 and <jats:italic>p<\/jats:italic>\u2009=\u20090.036, respectively). The D\u2010dimer level 3\u00a0months after TKA was also higher in the LT group than in the CT group (<jats:italic>p<\/jats:italic>\u2009=\u20090.028), but there was no difference in DVT incidence between the two groups (n.s.). Additionally, there were no significant differences in the other variables between the groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although the limited use of tourniquets did not increase the operation time, blood loss, or transfusion rate, this study found that the limited use of tourniquets would not provide additional meaningful benefit in reducing pain and early functional restoration after TKA when applying the ERAS protocol.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>I<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-022-07228-4","type":"journal-article","created":{"date-parts":[[2022,11,28]],"date-time":"2022-11-28T01:05:06Z","timestamp":1669597506000},"page":"1089-1097","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The limited use of a tourniquet during total knee arthroplasty under a contemporary enhanced recovery protocol has no meaningful benefit: a prospective randomized controlled trial"],"prefix":"10.1002","volume":"31","author":[{"given":"Na\u2010Kyoung","family":"Lee","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Seoul National University Bundang Hospital 82, Gumi\u2010ro 173 Beon\u2010gil, Bundang\u2010gu, Gyeonggi\u2010do 13620 Seongnam\u2010si South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seong In","family":"Lee","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Seoul National University Bundang Hospital 82, Gumi\u2010ro 173 Beon\u2010gil, Bundang\u2010gu, Gyeonggi\u2010do 13620 Seongnam\u2010si South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8597-1054","authenticated-orcid":false,"given":"Chong Bum","family":"Chang","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Seoul National University Bundang Hospital 82, Gumi\u2010ro 173 Beon\u2010gil, Bundang\u2010gu, Gyeonggi\u2010do 13620 Seongnam\u2010si South Korea"},{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery Seoul National University College of Medicine Seoul South 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September 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 November 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 November 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no competing financial interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This prospective, randomized controlled trial was conducted in accordance with the Declaration of Helsinki. The study was approved by the institutional review board of Seoul National University Bundang Hospital, Gyeonggi-do, Korea (B-2009\u2013634-004). The clinical trial was registered at the Clinical Research Information Service (KCT0005631).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Written informed consent was obtained from all patients to participate in this study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}