Tourniquet, tranexamic acid, and computer-assisted cryotherapy in primary total knee arthroplasty: A retrospective cohort study.

This study aimed to evaluate the comparative efficacy of 4 peri-operative strategies - tourniquet-alone (T-only), tourniquet with computer-assisted cryotherapy (T + CAC), tourniquet with combined intravenous (IV) and intra-articular (IA) tranexamic acid (T + TXA), and a tourniquet-free approach (T-free) - on hemostasis, pain management, and early functional recovery following primary total knee arthroplasty (TKA). In this retrospective comparative study, 213 patients undergoing primary TKA were stratified into 4 groups: Group 1 (tourniquet-only, n = 54), Group 2 (tourniquet + CAC, n = 52), Group 3 (tourniquet + TXA, n = 55), and Group 4 (tourniquet-free, n = 52). Outcome measures included surgical duration, intra-operative and post-operative blood loss, hemoglobin levels (pre-operative and post-operative days 1 and 3), length of stay (LOS), transfusion rates, inflammatory markers (C-reactive protein and erythrocyte sedimentation rate), numerical rating scale (NRS) pain scores, and opioid consumption. The tourniquet + TXA group demonstrated the lowest intra-operative bleeding and post-operative drainage volumes (P < .001). Crucially, this protocol resulted in significantly superior hemoglobin preservation on post-operative day 1 (P < .001) compared with the tourniquet-only and cryotherapy groups. On post-operative day 3, although the overall variance analysis indicated a trend (P = .064), the specific post hoc evaluation confirmed a statistically significant advantage of the tourniquet + TXA protocol. Even after rigorous statistical correction, the TXA group maintained significantly higher hemoglobin levels than the tourniquet-only group (P adj. = .050), demonstrating a sustained clinical benefit in blood conservation. The tourniquet + CAC group exhibited the most favorable analgesic profile, with significantly lower NRS pain scores and reduced opioid consumption (P = .004). The tourniquet-free group had the longest surgical duration (P < .001). The tourniquet-only group demonstrated the highest LOS. A pneumatic tourniquet used alongside combined IV and IA TXA provides the most effective strategy for minimizing blood loss and preserving hemoglobin levels, achieving hemostatic safety comparable to that of tourniquet-free surgery without prolonging operative time. Concurrently, CAC significantly enhanced post-operative analgesia and reduced opioid reliance. These findings suggest that TXA may improve peri-operative blood management, whereas CAC may provide better early analgesic control, thereby helping clinicians tailor peri-operative strategies to enhance recovery and patient safety after TKA.