Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 21, Issue 12, pp 2790–2799 | Cite as

A randomized double-blind clinical trial of tourniquet application strategies for total knee arthroplasty

  • Giedrius KvederasEmail author
  • Narunas Porvaneckas
  • Audrius Andrijauskas
  • Christer H. Svensen
  • Juozas Ivaskevicius
  • Justas Mazunaitis
  • Ugne Marmaite
  • Povilas Andrijauskas



The optimal timing of pneumatic lower limb tourniquet application during primary elective total knee arthroplasty surgery (TKA) is a matter of debate. Most previous reports have failed to show significant differences between different tourniquet timings. The aim of the work was to determine how three strategies of lower limb pneumatic tourniquet application affect the outcome for TKA patients.


Forty-three patients who undergo TKA were randomized into one of the three groups, and 36 of these patients completed the study. The tourniquet was inflated just before incision and deflated after the hardening of the cement for twelve patients (Group 1), it was inflated just before cement application and deflated after its hardening for another twelve patients (Group 2), and it was inflated before incision and deflated after the last suture of the skin for a further twelve patients (Group 3). Fit-to-discharge criteria and six methods for calculating estimated blood loss were used.


The estimated blood loss in Group 1 was lower than in Group 2, as determined by six methods of calculation (p < 0.05). Estimated blood loss in Group 3 was lower than in Group 2, as determined by one method (p = 0.050). The mobilization performance in Group 1 was better than in Group 2 (p = 0.023) and in Group 3 (p = 0.033). Group 1 was better fit to discharge than Group 3 (p = 0.030).


Inflation of an automatic pneumatic lower limb tourniquet before skin incision and its deflation after hardening of cement tends to give better outcomes in TKA patients during six postoperative days. The estimated blood loss was highest when the tourniquet was inflated just before cement application and deflated after its hardening.

Level of evidence



Total knee arthroplasty Automatic pneumatic tourniquet Perioperative blood loss Functional outcomes Hospital stay Fluid therapy Goal-directed management 



The project was supported by an ESA Research Grant 2009.

Conflict of interest

None of the authors has any conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Giedrius Kvederas
    • 1
    Email author
  • Narunas Porvaneckas
    • 2
  • Audrius Andrijauskas
    • 3
  • Christer H. Svensen
    • 4
  • Juozas Ivaskevicius
    • 3
  • Justas Mazunaitis
    • 1
  • Ugne Marmaite
    • 5
  • Povilas Andrijauskas
    • 5
  1. 1.Faculty of MedicineVilnius UniversityVilniusLithuania
  2. 2.Clinic of Rheumatology, Orthopaedics, Traumatology, Plastic and Reconstructive SurgeryVilnius UniversityVilniusLithuania
  3. 3.Clinic of Anaesthesiology and Intensive CareVilnius UniversityVilniusLithuania
  4. 4.Department of Clinical Science and Education, Section of Anaesthesiology and Intensive CareKarolinska Institutet/SödersjukhusetStockholmSweden
  5. 5.Medical AcademyLithuanian University of Health SciencesKaunasLithuania

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