title: An effective method to reduce ischemia time during total knee arthroplasty.
abstract: OBJECTIVE
  Because of controversy regarding timing of tourniquet release during total knee arthroplasty (TKA), a closed arthrotomy as a tamponade for effective hemostasis was used to save ischemia time. The study was to verify the safety and efficacy on clinical issues.
  
  
  METHODS
  A prospective cohort study was conducted on 72 consecutive unilateral primary TKAs. They were divided into two groups according to different timing of tourniquet release. The study group was composed of 36 index procedures with an intra-operative release after a tight arthrotomy closure; while the remaining 36 TKAs with a tourniquet application throughout the procedure comprised the comparative group. In all operations, no drain was used to augment the intra-articular tamponade.
  
  
  RESULTS
  In the study group, the tourniquet time was significantly shorter (p<0.001), and thus ischemic duration and perioperative blood loss were reduced. The postoperative course was similar on the basis of analgesics consumption and inpatient stay, but better earlier functional recovery as well as subjective performance was observed at early postoperative follow-ups.
  
  
  CONCLUSIONS
  The results suggest that a closed tamponade with arthrotomy closure and drainage avoidance is an effective hemostasis to reduce ischemia time during TKAs.
authors.affiliation: Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Chang
authors.forename: Sheng-Min
authors.initials: SM
authors.lastname: Lan
authors.forename: Ta-Wei
authors.initials: TW
authors.lastname: Tai
authors.forename: Kuo-An
authors.initials: KA
authors.lastname: Lai
authors.forename: Chyun-Yu
authors.initials: CY
authors.lastname: Yang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006403:Hematologic Tests; D006488:Hemostasis, Surgical; D006801:Humans; D007511:Ischemia; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011446:Prospective Studies; D020127:Recovery of Function; D013630:Tampons, Surgical; D013997:Time Factors; D014111:Tourniquets; D016896:Treatment Outcome