title: Comparison of three different tourniquet application strategies for minimally invasive total knee arthroplasty: a prospective non-randomized clinical trial.
abstract: BACKGROUND
  It is still controversial on the optimal timing of tourniquet used in total knee arthroplasty (TKA). Most previous studies focused on the comparison of different tourniquet application in controversial TKA, while the aim of our work was to compare three strategies of tourniquet application in minimally invasive TKA.
  
  
  METHODS
  90 patients were enrolled in this study. Based on the different tourniquet application strategies, they were divided into three groups. Group A: using tourniquet during the whole surgery; Group B: tourniquet inflated before incision and deflated after the hardening of the cement; Group C: using tourniquet during the cementation. Blood loss and serum levels of C-reactive protein, IL-6, creatine kinase and myoglobin were checked preoperatively. The HSS knee score, VAS pain score, range of motion (ROM), limb swelling and hospital stays were also recorded.
  
  
  RESULTS
  The mean levels of Hb and Hct were lower in Group C (104.2 ± 10.4 g/L, 31.8 ± 3.2 %) than those in Groups A (111.4 ± 14.4 g/L, p = 0.035; 34.1 ± 4.1 %, p = 0.032) and B (112.8 ± 14.3 g/L, p = 0.013; 34.5 ± 3.7 %, p = 0.011) immediately after the surgery. Compared with Groups A and B, both serum inflammation and muscle damage markers were lower in Group C. There were no significant differences between the groups in terms of HSS knee score, ROM, estimated blood loss, swelling ratio, VAS pain score and hospital stays.
  
  
  CONCLUSIONS
  Using a tourniquet full time in minimally invasive TKA causes less intraoperative blood loss and more excessive inflammation and muscle damage. However, the advantage of part-time using tourniquet did not show in early functional outcomes.
authors: Department of Orthopaedics, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, People's Republic of China, Zey.huang@gmail.com.
authors: Ze Yu
authors: ZY
authors: Huang
authors: Fu Xing
authors: FX
authors: Pei
authors: Jun
authors: J
authors: Ma
authors: Jing
authors: J
authors: Yang
authors: Zong Ke
authors: ZK
authors: Zhou
authors: Peng De
authors: PD
authors: Kang
authors: Bin
authors: B
authors: Shen
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D016207:Cytokines / Q000097:blood; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000378:metabolism; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010003:Osteoarthritis / Q000097:blood / Q000601:surgery; D011183:Postoperative Complications; D011446:Prospective Studies; D014111:Tourniquets
chemical_list: D016207:Cytokines; D006454:Hemoglobins