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Tourniquet Use Independently Predicts Early Quadriceps Muscle Inhibition Following Primary Total Knee Arthroplasty: A Dose-Response Analysis.

Altun O, Daşar U, Bozkurt M. · The Journal of arthroplasty · 2026

Researchers compared 110 knee replacement patients whose surgery used a tourniquet (a limb blood-flow cuff) versus those whose surgery did not, checking on days 1 and 3 whether patients could lift the straight leg off the bed \u2014 a sign the quadriceps is working. Quadriceps shutdown was far more common with a tourniquet (40.4% vs 18.9%), and tourniquet use, higher BMI, and longer surgery each independently predicted inhibition, with longer tourniquet time meaning greater risk.
Takeaway: Ask your surgeon whether a tourniquet is necessary and how long it will be used, since shorter or no tourniquet time is linked to faster early quad recovery after knee replacement.
Abstract (source)

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 observer. Multivariable logistic regressions were used to determine the 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 (OR = 1.23, P = 0.003), and operative duration (OR = 1.48, P

Conclusions: Tourniquet use is independently associated with impaired early quadriceps muscle recovery after TKA, with a dose-dependent effect. Higher body mass index and longer operative duration further increase the risk, supporting a patient-specific approach to tourniquet use. Level of evidence Level III, retrospective comparative cohort study.

Observational / cohortRecovery & Sleep
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