Tourniquet and closed-suction drains in total knee arthroplasty. No beneficial effects on bleeding management and knee function at a higher cost.
Blood loss is a major concern in total knee arthroplasty (TKA) along with postoperative knee function. The present study explores the impact of tourniquet (T) and closed-suction drains (D) on these parameters in TKA.



A prospective study was conducted on 111 patients admitted for TKA. Subjects were divided into three groups: 36 in group T+D+, 42 in T-D+ and 33 in T-D- (where T+: prolonged tourniquet use, T-: cementation-only tourniquet, D+: closed-suction drain use, and D-: no drain).



No statistically significant differences were observed among the three groups(T+D+, T-D+ and T-D-) for total blood loss, hemoglobin levels over the first six postoperative weeks and blood transfusion rate. Intraoperative bleeding was significantly reduced in T+ subjects compared to T- subjects (100±88mL vs. 279±235mL respectively, P<0.001), yet length of surgery was unaffected. Hidden blood loss was lower in D+ subjects compared to D- subjects (1161±554mL vs. 1667±554mL respectively, P<0.001), but was offset by the blood loss in the drains. Early postoperative range of motion (ROM) was superior in group T-D- compared to group T+D+. Nevertheless, postoperative week 6 ROM was similar between the 3 groups as was patient-reported postoperative pain. A patient with a drain represents 35min of extra nursing time and a total cost of $31.87 CAD.



Whole-course tourniquet and closed-suction drain use in TKA do not yield beneficial results while increasing costs. Their use is therefore deemed unnecessary.



III (case control prospective study).
Department of orthopedic surgery, hôpital Sacré-Cœur de Montréal, 5400, boulevard Gouin-Ouest, H4J 1C5 Montréal, Canada.
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Yin
Department of orthopedic surgery, hôpital Sacré-Cœur de Montréal, 5400, boulevard Gouin-Ouest, H4J 1C5 Montréal, Canada. Electronic address: Josee.delisle@outlook.com.
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Delisle
Department of orthopedic surgery, hôpital Sacré-Cœur de Montréal, 5400, boulevard Gouin-Ouest, H4J 1C5 Montréal, Canada.
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Banica
Université de Montréal, 2900, boulevard Édouard-Montpetit, H3T 1J4 Montréal, Canada.
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Senay
Department of orthopedic surgery, hôpital Sacré-Cœur de Montréal, 5400, boulevard Gouin-Ouest, H4J 1C5 Montréal, Canada; Department of orthopedic surgery, hôpital Jean-Talon, 1385, rue Jean-Talon Est, H2E 1S6 Montréal, Canada.
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Ranger
Department of orthopedic surgery, hôpital Sacré-Cœur de Montréal, 5400, boulevard Gouin-Ouest, H4J 1C5 Montréal, Canada; Department of orthopedic surgery, hôpital Jean-Talon, 1385, rue Jean-Talon Est, H2E 1S6 Montréal, Canada.
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Laflamme
Arthritis clinic & research center, Peking university people hospital, 11#, Xizhimen South avenue, Xicheng District, 100044 Beijing, China.
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Jun
Department of orthopedic surgery, hôpital Sacré-Cœur de Montréal, 5400, boulevard Gouin-Ouest, H4J 1C5 Montréal, Canada; Department of orthopedic surgery, hôpital Jean-Talon, 1385, rue Jean-Talon Est, H2E 1S6 Montréal, Canada.
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Fernandes
D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000191:economics / Q000295:instrumentation* / Q000379:methods; D016063:Blood Loss, Surgical / Q000451:nursing / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011792:Quebec; D016059:Range of Motion, Articular; D013396:Suction; D014111:Tourniquets; D016896:Treatment Outcome
Blood loss; Blood transfusion; Complications; Drainage; Range of motion; Total knee arthroplasty; Tourniquet