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Tourniquet Use During Cementation Only During Total Knee Arthroplasty: A Randomized Trial

  • Symposium: 2013 Knee Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Total knee arthroplasty with the use of a tourniquet during the entire operation has not been shown to improve the performance of the operation and may increase the risk of complications.

Questions/purposes

We asked whether the limited use of a tourniquet for cementation only would affect (1) surgical time; (2) postoperative pain and motion of the knee; (3) blood loss; or (4) complications such as risk of nerve injuries, quadriceps dysfunction, and drainage compared with use of a tourniquet throughout the procedure.

Methods

Seventy-one patients (79 knees) were randomized to either use of a tourniquet from the incision through cementation of the implants and deflated for closure (operative tourniquet group) or tourniquet use only during cementation (cementation tourniquet group). The initial study population was a minimum of 30 knees in each group as suggested for randomized studies by American Society for Testing and Materials standards; termination of the study was determined by power analysis performed after 40 knees in each group showed any statistical solution to our questions would require a minimum of 260 more cases. Patients were excluded who were considered in previous randomized studies as high risk for complications, which might be attributed to the tourniquet.

Results

There were no differences in terms of surgical time, pain scores, pain medicine requirements, range of motion, hemoglobin change, or total blood loss. One major complication (compartmental syndrome) occurred in a patient with tourniquet inflation until closure. No other complications were attributed to the use of a tourniquet.

Conclusions

With the numbers available, our results suggest that there are no important clinical differences between patients who had a tourniquet inflated throughout the procedure compared with those who had it inflated only during cementation. Tourniquet inflation for cementation only provides the benefit of bloodless bone for fixation and may eliminate the risks associated with prolonged tourniquet use.

Level of Evidence

Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Jennifer Okuno PT, and Don Shimabukuro PT, who provided the physical therapy on all of these patients.

Author information

Authors and Affiliations

  1. Lenox Hill Hospital, New York, NY, USA

    Rupesh Tarwala MD

  2. Department of Orthopedics, Keck Hospital of USC, 1520 San Pablo Street, Suite 200, Los Angeles, CA, 90033, USA

    Lawrence D. Dorr MD, Paul K. Gilbert MD & Zhinian Wan MD

  3. Good Samaritan Hospital, Los Angeles, CA, USA

    William T. Long MD

Authors
  1. Rupesh Tarwala MD
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  2. Lawrence D. Dorr MD
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  3. Paul K. Gilbert MD
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  4. Zhinian Wan MD
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  5. William T. Long MD
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Corresponding author

Correspondence to Lawrence D. Dorr MD.

Additional information

Funding was provided by Good Samaritan Hospital, Los Angeles, CA, USA (LDD, ZW, WTL).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Tarwala, R., Dorr, L.D., Gilbert, P.K. et al. Tourniquet Use During Cementation Only During Total Knee Arthroplasty: A Randomized Trial. Clin Orthop Relat Res 472, 169–174 (2014). https://doi.org/10.1007/s11999-013-3124-2

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  • DOI: https://doi.org/10.1007/s11999-013-3124-2

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