A randomized double-blind clinical trial of tourniquet application strategies for total knee arthroplasty.
OBJECTIVE
The optimal timing of pneumatic lower limb tourniquet application during primary elective total knee arthroplasty surgery (TKA) is a matter of debate. Most previous reports have failed to show significant differences between different tourniquet timings. The aim of the work was to determine how three strategies of lower limb pneumatic tourniquet application affect the outcome for TKA patients.


METHODS
Forty-three patients who undergo TKA were randomized into one of the three groups, and 36 of these patients completed the study. The tourniquet was inflated just before incision and deflated after the hardening of the cement for twelve patients (Group 1), it was inflated just before cement application and deflated after its hardening for another twelve patients (Group 2), and it was inflated before incision and deflated after the last suture of the skin for a further twelve patients (Group 3). Fit-to-discharge criteria and six methods for calculating estimated blood loss were used.


RESULTS
The estimated blood loss in Group 1 was lower than in Group 2, as determined by six methods of calculation (p < 0.05). Estimated blood loss in Group 3 was lower than in Group 2, as determined by one method (p = 0.050). The mobilization performance in Group 1 was better than in Group 2 (p = 0.023) and in Group 3 (p = 0.033). Group 1 was better fit to discharge than Group 3 (p = 0.030).


CONCLUSIONS
Inflation of an automatic pneumatic lower limb tourniquet before skin incision and its deflation after hardening of cement tends to give better outcomes in TKA patients during six postoperative days. The estimated blood loss was highest when the tourniquet was inflated just before cement application and deflated after its hardening.
Faculty of Medicine, Vilnius University, Siltnamiu 29, 04130, Vilnius, Lithuania, giedrius.kvederas@mf.vu.lt.
Giedrius
G
Kvederas
Narunas
N
Porvaneckas
Audrius
A
Andrijauskas
Christer H
CH
Svensen
Juozas
J
Ivaskevicius
Justas
J
Mazunaitis
Ugne
U
Marmaite
Povilas
P
Andrijauskas
D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001843:Bone Cements; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014111:Tourniquets; D016896:Treatment Outcome
D001843:Bone Cements