JOA - 2026-08-24 - Journal Article
Tourniquet Use Independently Predicts Early Quadriceps Inhibition Following Primary Total Knee Arthroplasty: A Dose-Response Analysis.
Altun O, Daşar U, Bozkurt M
Topics
Key Takeaway
Tourniquet use independently predicts early quadriceps inhibition after primary TKA with an OR of 6.25, and each additional unit of tourniquet duration increases inhibition risk by 65% (OR=1.65).
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Summary
This retrospective comparative cohort study evaluated whether tourniquet use independently predicts early quadriceps inhibition (inability to perform active SLR) in 110 consecutive primary TKA patients allocated to tourniquet (n=57) or tourniquet-free (n=53) groups based on a temporal change in surgical practice. Quadriceps inhibition was significantly more frequent in the tourniquet group (40.4% vs. 18.9%, P=0.023), and SLR performance on POD1 was lower (28.1% vs. 52.8%, P=0.008). Multivariable logistic regression identified tourniquet use (OR=6.25), BMI (OR=1.23), and operative duration (OR=1.48) as independent predictors, with a dose-response relationship between tourniquet duration and inhibition risk (OR=1.65 per unit increase, AUC=0.834).
Key Limitation
Temporal cohort allocation means the tourniquet and tourniquet-free groups are not contemporaneous, making it impossible to exclude confounding from concurrent changes in anesthesia, analgesia, or rehabilitation protocols.
Original Abstract
BACKGROUND
The purpose of the study was to evaluate the effect of tourniquet use on early postoperative quadriceps muscle function following primary total knee arthroplasty (TKA) and to identify independent predictors of quadriceps muscle inhibition.
METHODS
In this retrospective comparative cohort study, 110 consecutive patients undergoing primary unilateral TKA were included. Patients were allocated to tourniquet (n = 57) or tourniquet-free (n = 53) groups based on a temporal change in surgical practice. Quadriceps muscle inhibition was defined as the inability to perform an active straight leg raise (SLR) with the knee in full extension. Straight leg raise performance was assessed on postoperative days one and three by a blinded independent observesr. Multivariable logistic regressions were used to determine independent predictors.
RESULTS
Quadriceps muscle inhibition was more frequent in the tourniquet group (40.4 versus 18.9%, P = 0.023), while SLR performance on postoperative day one was higher in the tourniquet-free group (52.8 versus 28.1%, P = 0.008). Multivariable analyses identified tourniquet use (odds ratio [OR] = 6.25, P = 0.002), body mass index (BMI) (OR = 1.23, P = 0.003), and operative duration (OR = 1.48, P < 0.001) as independent predictors. The model demonstrated good discrimination (area under the curve [AUC] = 0.834). A significant dose-response relationship was observed between tourniquet duration and inhibition risk (OR = 1.65, P < 0.001).
CONCLUSION
Tourniquet use is independently associated with impaired early quadriceps muscle recovery after TKA, with a dose-dependent effect. Higher BMI and longer operative duration further increase risk, supporting a patient-specific approach to tourniquet use.