title: The effects of tourniquet use in total knee arthroplasty: a randomized, controlled trial.
abstract: OBJECTIVE
  Tourniquets are still widely used in total knee arthroplasty (TKA), although they may be associated with several adverse effects. An observer-blinded, randomized, controlled trial was performed to evaluate the effects of tourniquet use in TKA.
  
  
  METHODS
  Fifty participants who underwent staged bilateral TKA were recruited for this study. The first-side TKA was randomly allocated to either long-duration tourniquet use or short-duration tourniquet use followed by a 3-month washout period and crossover to the other tourniquet strategy for the opposite-side TKA. Blood loss was monitored perioperatively. The operating time, allogeneic blood transfusion rate, thigh pain, knee pain, limb swelling, clinical outcome as measured by the Likert-type Western Ontario and McMaster University (WOMAC) score, straight leg raising and knee active range of motion (ROM) were also recorded.
  
  
  RESULTS
  The long-duration tourniquet group exhibited reduced total blood loss [-99.1 ml, 95 % confidence interval (CI) -168.1 to -30.1, P = 0.0411] and intraoperative blood loss (-225.2 ml, 95 % CI -369.5 to -80.9, P = 0.0071) compared with the short-duration tourniquet group. However, there were greater postoperative blood loss (69.6 ml, 95 % CI 21.1 to 118.2, P = 0.0282) and hidden blood loss (52.8 ml, 95 % CI 10.5 to 95.1, P = 0.0332) in the long-duration tourniquet group. The short-duration tourniquet group showed better outcomes for thigh and knee pain, limb swelling, WOMAC score at 6-week follow-up, straight leg raising and knee ROM. Similar allogeneic blood transfusion rates were observed for both groups.
  
  
  CONCLUSIONS
  Total and intraoperative blood losses were reduced with the long-duration tourniquet use, whereas the short-duration tourniquet use would reduce postoperative and hidden blood losses without increasing the allogeneic blood transfusion rate. In addition, short-duration tourniquet use would result in faster recovery and less pain during the early rehabilitation period following TKA.
  
  
  METHODS
  I.
authors.affiliation: Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Xizhimen South Street No. 11, Beijing, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Wang
authors.affiliation: Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Xizhimen South Street No. 11, Beijing, China.
authors.forename: Songjia
authors.initials: S
authors.lastname: Ni
authors.affiliation: Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Xizhimen South Street No. 11, Beijing, China.
authors.forename: Zhichang
authors.initials: Z
authors.lastname: Li
authors.affiliation: Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Xizhimen South Street No. 11, Beijing, China.
authors.forename: Qunjie
authors.initials: Q
authors.lastname: Zhong
authors.affiliation: Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Xizhimen South Street No. 11, Beijing, China.
authors.forename: Rujun
authors.initials: R
authors.lastname: Li
authors.affiliation: Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Xizhimen South Street No. 11, Beijing, China.
authors.forename: Hu
authors.initials: H
authors.lastname: Li
authors.affiliation: Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Xizhimen South Street No. 11, Beijing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Ke
authors.affiliation: Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Xizhimen South Street No. 11, Beijing, China. linjianhao@pkuph.edu.cn.
authors.forename: Jianhao
authors.initials: J
authors.lastname: Lin
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D004487:Edema / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D009864:Ontario; D061646:Operative Time; D017063:Outcome Assessment, Health Care / Q000379:methods; D019106:Postoperative Hemorrhage / Q000209:etiology; D011184:Postoperative Period; D016059:Range of Motion, Articular; D013997:Time Factors; D014111:Tourniquets / Q000009:adverse effects*
keywords: Blood loss; Clinical outcome; Total knee arthroplasty; Tourniquet