Clinical benefit analysis of no tourniquet use in modified single-plane high tibial osteotomy: a retrospective cohort study

Modified single-plane osteotomy is a modified technique of medial opening-wedge high tibial osteotomy (OWHTO). This study aimed to investigate the effects of tourniquet use versus non-use during modified single-plane high tibial osteotomy (SPHTO) on perioperative recovery and clinical outcomes in patients. A retrospective analysis was performed on the clinical data of 73 patients with medial compartment knee osteoarthritis (KOA) who underwent unilateral SPHTO at the Third Affiliated Hospital of Beijing University of Chinese Medicine from January 2024 to January 2025. Patients were divided into the observation group (without tourniquet use, n = 35) and the control group (with tourniquet use, n = 38) based on whether a tourniquet was applied intraoperatively. All surgeries were conducted by the same team of surgeons, and all patients received standardized perioperative management. Preoperative baseline data, intraoperative indicators, perioperative recovery parameters, postoperative pain and functional scores, as well as the incidence of complications were compared between the two groups. There were no statistically significant differences in preoperative baseline data between the two groups, including age, gender distribution, body mass index (BMI), preoperative hemoglobin (Hb), and knee range of motion (ROM) (all P -value > 0.05). Intraoperatively, the intraoperative blood loss in the control group was significantly less than that in the observation group ( P -value < 0.05), while no statistically significant differences were observed in operation time, osteotomy distraction angle, and other indicators between the two groups (all P -value > 0.05). The hidden blood loss was (292.98 ± 45.72) mL in the control group and (206.95 ± 42.36) mL in the observation group, with the hidden blood loss in the control group being significantly higher than that in the observation group. During the perioperative period, there were no statistically significant differences in total blood loss, postoperative Hb decrease value, and length of hospital stay between the two groups (all P -value > 0.05), and no blood transfusion was required in either group. Regarding postoperative pain and functional recovery, the visual analog scale (VAS) scores at 1, 3, and 5 days after surgery in the observation group were significantly lower than those in the control group (all P -value < 0.05); the ROM at 3 and 5 days after surgery was significantly greater in the observation group than in the control group (all P -value < 0.05); the Lysholm knee function scores at 1 and 3 months after surgery were significantly higher in the observation group than in the control group (all P -value < 0.05). In terms of complications, the incidence of complications in the observation group was significantly lower than that in the control group ( P -value < 0.05). The use of a tourniquet during SPHTO does not reduce perioperative total blood loss or the risk of complications. However, non-use of a tourniquet can achieve faster pain relief, increase knee range of motion, reduce tourniquet-related complications, and promote accelerated postoperative recovery.