title: Influence of the tourniquet on tibial cement mantle thickness in primary total knee arthroplasty.
abstract: OBJECTIVE
  The purpose of the study was whether the use of a tourniquet increases cement mantle thickness in primary total knee arthroplasty and influences the calculated blood loss and postoperative pain.
  
  
  METHODS
  Ninety patients with a primary total knee arthroplasty (TKA) were enroled in this prospective randomised trial and divided into a group with (n = 45) and without tourniquet (n = 45). The radiological tibial cement mantle thickness was evaluated postoperatively in four zones on anteroposterior and two zones on lateral radiographs, and values were cumulated. Additionally, the calculated blood loss and postoperative pain levels were recorded.
  
  
  RESULTS
  There was a median cumulative cement mantle thickness of 13 mm (range 8-19 mm) without tourniquet and of 14.2 mm (range 9-18 mm) with tourniquet (p = 0.009). The median calculated blood loss was 0.6 L (range 0.2-2.0 L) without and 0.9 L (range 0.3-1.5 L) (p = 0.02) with tourniquet. Patient-reported postoperative pain levels were significantly higher in the tourniquet group during mobilisation (p = 0.01) and at rest (p = 0.001).
  
  
  CONCLUSIONS
  The use of a tourniquet in primary TKA increased the tibial cement mantle thickness but also increased the postoperative calculated blood loss and postoperative pain. Surgeons might take this into consideration for decision-making whether to use a tourniquet during TKA.
  
  
  METHODS
  II.
authors.affiliation: Orthopaedic Department, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. Tilman.pfitzner@charite.de.
authors.forename: Tilman
authors.initials: T
authors.lastname: Pfitzner
authors.affiliation: Orthopaedic Department, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: von Roth
authors.affiliation: Orthopädische Chirurgie München, Steinerstraße 6, 81369, Munich, Germany.
authors.forename: Ninja
authors.initials: N
authors.lastname: Voerkelius
authors.affiliation: Orthopädische Chirurgie München, Steinerstraße 6, 81369, Munich, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Mayr
authors.affiliation: Orthopaedic Department, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Perka
authors.affiliation: Orthopädische Chirurgie München, Steinerstraße 6, 81369, Munich, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Hube
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation; D016063:Blood Loss, Surgical; D001843:Bone Cements; D002484:Cementation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000601:surgery*; D010149:Postoperative Pain; D019106:Postoperative Hemorrhage; D011446:Prospective Studies; D011859:Radiography; D013977:Tibia / Q000000981:diagnostic imaging* / Q000601:surgery*; D014111:Tourniquets
chemical_list: D001843:Bone Cements
keywords: Blood loss; Cement mantle thickness; Cementing technique; Total knee arthroplasty; Tourniquet