title: Use of a pneumatic tourniquet in total knee arthroplasty increases the risk of distal deep vein thrombosis: A prospective, randomized study.
abstract: BACKGROUND
  There has been controversy regarding the incidence of deep vein thrombosis (DVT) after total knee arthroplasty (TKA) with or without the use of a tourniquet. The aim of this randomized, prospective study was to clarify the effects of tourniquet use on DVT in TKA.
  
  
  METHODS
  The subjects were 109 patients scheduled to undergo TKA from April 2008 to March 2009 before the establishment of the American Association of Orthopedic Surgeons (AAOS) practice guidelines. They were randomized into two groups: 51 patients in the tourniquet group (group T) and 52 patients in the control group without a tourniquet (group C). We investigated the thrombotic presence using ultrasonography one week after surgery and compared both groups.
  
  
  RESULTS
  There was no difference in the rate of proximal DVTs (P=0.63). However, the risk of distal DVT was significantly higher in group T than in group C (52.9% vs. 23.1%; P=0.002).
  
  
  CONCLUSIONS
  Use of the tourniquet in TKA increased the risk of distal DVT.
authors.affiliation: Department of Orthopaedic Surgery, Wajo Eniwa Hospital, Eniwa, Hokkaido, Japan. Electronic address: noriakki@hotmail.co.jp.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Mori
authors.affiliation: Department of Orthopaedic Surgery, Wajo Eniwa Hospital, Eniwa, Hokkaido, Japan.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Kimura
authors.affiliation: Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Hokkaido, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Onodera
authors.affiliation: Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Hokkaido, Japan.
authors.forename: Norimasa
authors.initials: N
authors.lastname: Iwasaki
authors.affiliation: Department of Cardiovascular Medicine, Wajo Eniwa Hospital, Eniwa, Hokkaido, Japan.
authors.forename: Izumi
authors.initials: I
authors.lastname: Nakagawa
authors.affiliation: Department of Orthopaedic Surgery, Wajo Eniwa Hospital, Eniwa, Hokkaido, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Masuda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D020370:Osteoarthritis, Knee / Q000601:surgery*; D011446:Prospective Studies; D012307:Risk Factors; D014111:Tourniquets / Q000009:adverse effects*; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*
keywords: Deep vein thrombosis; Total knee arthroplasty; Tourniquet