title: Benefits of Limited Use of a Tourniquet Combined With Intravenous Tranexamic Acid During Total Knee Arthroplasty.
abstract: BACKGROUND
  Blood loss during total knee arthroplasty (TKA) may require blood transfusions that are associated with increased risk, morbidity, and cost. Multiple techniques exist to reduce blood loss in TKA, including the use of a tourniquet and tranexamic acid (TXA). While multiple studies suggest that TXA is effective in reducing blood loss, the use of a tourniquet is more controversial. We studied the combined effect of TXA with a limited-use tourniquet on blood loss and complications in the setting of primary TKA.
  
  
  METHODS
  A retrospective review of a prospectively gathered arthroplasty database from a single institution was performed. We compared our limited-use cohort data with the published results of randomized controlled trials evaluating the effectiveness of tourniquets used during the entire TKA procedure.
  
  
  RESULTS
  Fifty-one procedures from our institution's database met the inclusion criteria. TXA (administered in a single 15-mg/kg dose) with limited tourniquet use (a mean duration of 26.3 minutes) resulted in an average intraoperative estimated blood loss of 94.7 mL. The mean decrease in hemoglobin from the preprocedure baseline to postoperative day 1 was 2.6 ± 0.9 g/dL(P<0.001), and only 2 of the 51 procedures required a blood transfusion. When compared to recent randomized controlled trials, the 51 procedures demonstrated lower levels of blood loss, similar operative time, and no increase in morbidity or mortality.
  
  
  CONCLUSIONS
  Our study results suggest that using TXA in combination with a tourniquet during the cementation portion only of a TKA provides a reasonable operative time and low intraoperative blood loss without increasing perioperative morbidity or complications.
authors.affiliation: Department of Orthopedic Surgery, CAMC Physicians Group, Charleston, WV.
authors.forename: Alexander D
authors.initials: AD
authors.lastname: Rosenstein
authors.affiliation: Department of Orthopedics, New York University Lutheran, Brooklyn, NY.
authors.forename: Yehuda A
authors.initials: YA
authors.lastname: Michelov
authors.affiliation: Center for Health Services and Outcome Research, CAMC Health Education and Research Institute, Charleston, WV.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Thompson
authors.affiliation: Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Kaye
keywords: Arthroplasty–replacement–knee; blood transfusion; tourniquets; tranexamic acid