title: After early release of tourniquet in total knee arthroplasty, should it be reinflated or kept deflated? A randomized trial.
abstract: OBJECTIVE
  This study was undertaken to determine the efficacy of reinflation of the tourniquet after its early release in TKA compared to early release alone, in terms of surgical field visualization and operative time. We also questioned whether tourniquet reinflation after its early release is safe, with respect to post-operative blood loss, post-operative pain and other tourniquet-related complications.
  
  
  METHODS
  Two hundred and six patients undergoing TKA were randomly allocated to either the early release (deflation) group (n = 105) or reinflation after early release (reinflation) group (n = 101). Efficacy was measured in terms of surgical field visualization, specifically the number of wound clearances, and operative time. Safety outcomes were drained volume, decline in haemoglobin on post-operative days 2 and 5, the frequency of transfusion, knee and thigh pain visual analog scale, local wound complications, tourniquet site complications and other complications, including infection, deep vein thrombosis and pulmonary embolism.
  
  
  RESULTS
  Surgical field visualization was better in the reinflation group; however, the operative time did not differ between the two groups. There were no differences between the two groups in post-operative blood loss, decline in haemoglobin on days 2 and 5, transfusion rate, pain level, local complications and other complications.
  
  
  CONCLUSIONS
  Reinflation of tourniquet is a safe alternative to its early release after deflation in that it improves surgical field visualization during TKA.
  
  
  METHODS
  Therapeutic study, Level I.
authors.affiliation: Joint Reconstruction Center, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.
authors.forename: Young Gon
authors.initials: YG
authors.lastname: Na
authors.affiliation: Joint Reconstruction Center, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.
authors.forename: Ankur B
authors.initials: AB
authors.lastname: Bamne
authors.affiliation: Department of Orthopaedic Surgery and the Joint and Arthritis Research, Himchan Hospital, 404-3, Mok-dong, Yangcheon-gu, Seoul, 158-806, Republic of Korea.
authors.forename: Ho Hyun
authors.initials: HH
authors.lastname: Won
authors.affiliation: Joint Reconstruction Center, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea. osktk@snubh.org.|Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea. osktk@snubh.org.
authors.forename: Tae Kyun
authors.initials: TK
authors.lastname: Kim
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D061214:Patient Safety; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D011446:Prospective Studies; D014111:Tourniquets; D016896:Treatment Outcome
keywords: Early tourniquet release; Knee; Reinflation; Total knee arthroplasty; Tourniquet