title: Tourniquet application only during cement fixation in total knee arthroplasty: a double-blind, randomized controlled trial.
abstract: BACKGROUND
  The functional benefits of tourniquet application for short periods compared with standard duration applications during total knee arthroplasty surgery have not been well explored. We aimed to compare functional outcomes between tourniquet application of short duration (during cement fixation only) and tourniquet application of longer duration (from skin incision to just after cement fixation).
  
  
  METHODS
  We planned to randomize 230 patients to short and long duration groups. The primary outcome was Oxford Knee Score at 10 weeks post-surgery. In-hospital blood transfusion rate was also a primary safety measure. Serial measures of knee function were taken together with knee range, quadriceps lag and timed stair tests.
  
  
  RESULTS
  The trial was discontinued after randomization of 65 patients. Interim analysis indicated a higher risk of transfusion (odds ratio 7.38, P= 0.015) in the short duration group. No significant difference was observed in Oxford Knee Score at 10 weeks. There were no between-group differences in rate of recovery up to 52 weeks for any outcome.
  
  
  CONCLUSIONS
  Restricting tourniquet application to the period of cementing is associated with a significantly higher risk of transfusion. This approach is impractical if it is not offset by gains in functional recovery.
authors.affiliation: South Western Sydney Local Health Network, Orthopaedic Department, Liverpool Hospital, Liverpool, NSW 1871, Australia. rajatmittal.syd@gmail.com
authors.forename: Rajat
authors.initials: R
authors.lastname: Mittal
authors.forename: Victoria
authors.initials: V
authors.lastname: Ko
authors.forename: Sam
authors.initials: S
authors.lastname: Adie
authors.forename: Justine
authors.initials: J
authors.lastname: Naylor
authors.forename: Jaykar
authors.initials: J
authors.lastname: Dave
authors.forename: Chandrakant
authors.initials: C
authors.lastname: Dave
authors.forename: Ian A
authors.initials: IA
authors.lastname: Harris
authors.forename: Danella
authors.initials: D
authors.lastname: Hackett
authors.forename: David
authors.initials: D
authors.lastname: Ngo
authors.forename: Susan
authors.initials: S
authors.lastname: Dietsch
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation / Q000379:methods* / Q000534:rehabilitation; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion / Q000706:statistics & numerical data; D001843:Bone Cements; D004311:Double-Blind Method; D057239:Early Termination of Clinical Trials; D005260:Female; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D020127:Recovery of Function; D013997:Time Factors; D014111:Tourniquets
chemical_list: D001843:Bone Cements