title: Effects of tourniquet use on blood loss and soft-tissue damage in total knee arthroplasty: a randomized controlled trial.
abstract: BACKGROUND
  Although tourniquets are widely used in total knee arthroplasty, their effectiveness in reducing blood loss and their influence on the postoperative course remain unclear. Tourniquet-related soft-tissue damage is a related concern. We performed a prospective, randomized, controlled trial to clarify the effect of tourniquets in total knee arthroplasty.
  
  
  METHODS
  Seventy-two patients undergoing total knee arthroplasty were randomly allocated to a tourniquet or non-tourniquet group. Blood loss and changes in C-reactive protein, creatine phosphokinase, and other indicators of soft-tissue damage were monitored preoperatively and postoperatively on Days 1, 2, and 4. Thigh pain, knee pain, limb swelling, rehabilitation progress, and hospital stays were also recorded for comparison.
  
  
  RESULTS
  Patients in the tourniquet group showed smaller decreases in hemoglobin (mean and standard deviation, 2.6 ± 0.9 versus 3.7 ± 1.3 g/dL) and hematocrit (7.6% ± 2.8% versus 10.4% ± 4.0%), less calculated blood loss (303 ± 119 versus 423 ± 197 mL), and smaller increases in C-reactive protein (peak value, 175 ± 55 versus 139 ± 75 mg/dL) and creatine phosphokinase (peak value, 214 ± 89 versus 162 ± 104 U/L) compared with those in the non-tourniquet group. There was slightly less postoperative pain in the non-tourniquet group. There were no significant differences between the groups in terms of swelling, rehabilitation progress, or hospital stays.
  
  
  CONCLUSIONS
  The use of a tourniquet during total knee arthroplasty was effective for reducing blood loss and avoiding excessive postoperative inflammation and muscle damage. The use of a tourniquet was related to slightly more postoperative pain but did not affect postoperative recovery.
authors: Department of Orthopaedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 183 Sheng-Li Road, 704, Tainan, Taiwan. david0803@gmail.com
authors: Ta-Wei
authors: TW
authors: Tai
authors: Chih-Wei
authors: CW
authors: Chang
authors: Kuo-An
authors: KA
authors: Lai
authors: Chii-Jeng
authors: CJ
authors: Lin
authors: Chyun-Yu
authors: CY
authors: Yang
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D015415:Biomarkers / Q000097:blood; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D016014:Linear Models; D008297:Male; D017695:Soft Tissue Injuries / Q000517:prevention & control*; D014111:Tourniquets; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006454:Hemoglobins