Effects of Surgical Approach and Tourniquet Use on Patient-Reported Outcomes Following Total Knee Arthroplasty: A Pilot Randomized Clinical Trial
Bibliographic record
Abstract
Introduction: Total knee arthroplasty (TKA) is one of the most successful procedures for the treatment of severe knee osteoarthritis. Various surgical approaches have been investigated in the hopes of improving postoperative outcomes. Two include the medial parapatellar (standard) and midvastus. As the midvastus approach does not disrupt the extensor mechanism, it may be advantageous for functional recovery, however length of stay and long-term function are similar between approaches. Tourniquet use during TKA has conflicting results in the literature. We hypothesized that a future trial comparing outpatient versus standard TKA could appropriately use either surgical approach with or without a tourniquet. Therefore, the objective of this pilot randomized trial was to compare postoperative pain, function, quality of life, and satisfaction between patients who underwent a medial parapatellar or midvastus approach for TKA ± tourniquet use. Methods: We conducted a randomized trial with a two-by-two factorial design to compare the medial parapatellar to the midvastus surgical approach for TKA ± tourniquet use. The Short Form-12 (SF-12), Western Ontario McMaster Osteoarthritis Index (WOMAC), and Knee Society Score (KSS) were collected at baseline, postoperatively at two, six, 12 weeks, and one year. Results: Eighty-three patients were included. Postoperative WOMAC scores were statistically but not clinically higher at six weeks and three months in favour of no tourniquet use. There were no differences in postoperative WOMAC scores between approaches. Short Form-12 and KSS scores increased in both groups with no significant differences postoperatively (p > 0.05). Conclusion: There were no clinically significant differences in postoperative pain, function, quality of life, or satisfaction between surgical approaches or whether a tourniquet was used. As such, both surgical approaches ± tourniquet use are safe and reliable. We believe a future larger randomized trial could likely incorporate either surgical approach or tourniquet preferences without significant impact on patient reported outcomes.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".