The Influence Of Intraoperative Approach Selection And Tourniquet Use On Early Prognosis After Total Knee Arthroplasty:a Propensity Score Matched Analysis

Background: Osteoarthritis(OA)is a chronic,non-inflammatory joint disease,mainly occurring in middle-aged and post-middle-aged people.Total Knee Arthroplasty(TKA)is a common surgical procedure for patients with advanced knee osteoarthritis who suffer from pain and impaired function.Despite significant advances in surgery and anesthesia,nearly 20% of patients with knee OA report dissatisfaction after TKA because their pain and function have not improved or even their symptoms are more severe than before.Over the past decade,a significant number of patients after TKA have been studied to look for predictors of postoperative chronic pain and functional recovery,both preoperatively and intraoperatively.Various retrospective and meta-analysis trials have been conducted,often with conflicting results.A retrospective case-control study,the paper discusses the influence TKA early postoperative pain and functional recovery of two common factors(surgical approach,the use of a tourniquet),using Propensity Score matching(Propensity Score-Matched,PSM)method to reduce the research object bias on the experimental results,the influence of baseline data to provide theoretical basis for the clinical work in the future.Objective: To explore the effects of intraoperative approach selection and tourniquet use on early postoperative pain and functional recovery in patients with knee osteoarthritis undergoing TKA surgery.Materials and Methods:Analyzed retrospectively from January 2018 to December2020,the provincial hospital bone subject line TKA surgery of 149(which USES the medial patellar beside the road and the patients of femoral medial muscle of 53 cases and 96 cases respectively,the use of a tourniquet and did not use a tourniquet patients109 cases and 40 cases)respectively,using rotating cases information patients were retrospectively analyzed basic information(height,weight,age,gender,etc.),and preoperative patients with knee joint function assessment(Keen Society Score.KSS),Western Ontario and Mc Master University Osteoarthritis Index(WOMAC),and Knee Range of Motion(ROM).Patients were followed up 3 months after surgery by outpatient or telephone.Follow-up data included postoperative KSS score,WOMAC score,range of motion(ROM)of knee joint,and Forgotten joint score(FJS).The impact of differences in baseline data between groups on the results was reduced by PSM matching,and the early functional recovery and pain relief of patients undergoing TKA surgery were evaluated by comparing the joint scores and range of motion at preoperative and postoperative 3 months.Results: After 1:1 allocation by PSM method,39 patients with medial parapatellar approach and via medial vastus muscle approach were obtained,and 29 patients with and without tourniquet were obtained.No serious complications such as deep vein thrombosis,prosthesis loosening or periprosthesis fracture occurred in the enrolled patients during the follow-up period of 3 months.In surgical approach in the control experiment,midvastus approach and medial parapelatellar approach group compared with the postoperative WOMAC score [(33.5 ± 4.5),(37.2± 7.8)],KSS function score[(77.1 ±13.9),(70.2± 13.8)] comparing the results with statistical difference(p < 0.05),and in the use of a tourniquet contrast experiments,intraoperative use of a tourniquet and the use of a tourniquet group compared with the postoperative WOMAC score[(36.6 ± 6.8),(32.7± 5.3)].KSS functional score [(68.7±15.9(78.5±15.2)] showed statistically significant difference(P < 0.05),while other results(including KSS clinical score,joint ROM,and FJS score)showed no statistically significant difference between the two experiments.Conclusions: This study elucidates the influence of two common intraoperative factors on early functional recovery and pain relief in patients with osteoarthritis undergoing TKA.Intraoperative midvastus approach acompared with medial parapelatellar approach and intraoperative non-tourniquet compared with tourniquet showed advantages in early postoperative functional recovery and pain,but similar results in early improvement in range of motion and forgotten joint amnesia score.