A new tourniquet system that determines pressures in synchrony with systolic blood pressure in knee surgery


This study reports the results of the clinical use of a new tourniquet system for surgery related to knee joint that can determine tourniquet pressure in synchrony with systolic blood pressure (SBP). We prospectively applied additional pressure of 100 mmHg based on the SBP recorded just before infiltration of tourniquet in 163 consecutive procedures, which consisted of 73 TKA related surgeries, 42 arthroscopic related surgeries, 20 ACL reconstructed surgeries, 15 ORIF, and 13 other surgeries. After the infiltration, the tourniquet pressure was automatically synchronized with the SBP. The interval of the measurement of blood pressure was every 2.5 min. The average durations of the operation and tourniquet use were 56 (range 6–134) and 56 (range 8–125) min, respectively. The average initial systolic tourniquet pressure was 207 mmHg (range 178–302). The average maximum changes during surgery were 37 mmHg (range 2–102) systolic and 23 mmHg (range 5–67) diastolic. The average maximum systolic pressure changes during 2.5 min interval were 20 mmHg (range 5–97). All cases kept a good operative field without measurable bleeding and there were no postoperative complications.Sixty-eight (42%) cases had a lower intra-operative SBP than the initial value. Since a tourniquet should be applied at the lowest pressure, and for the shortest amount of time possible, the new system appears to be practical and reasonable for maintaining a bloodless surgical field, as compared to conventional tourniquets, which maintain the initial pressure between 300 and 350 mmHg (253 words).

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. 1.

    Abdel-Salam A, Eyres KS (1995) Effects of tourniquet during total knee arthroplasty. A prospective randomized study. J Bone Joint Surg Br 77:250–253

    PubMed  CAS  Google Scholar 

  2. 2.

    Adalberth G, Byström S, Kolstad K, Mallmin H, Milbrink J (1998) Postoperative drainage of knee arthroplasty is not necessary. Acta Orthop Scand 69:475–478

    PubMed  CAS  Google Scholar 

  3. 3.

    Arciero RA, Scoville CR, Hayda RA, Snyder RJ (1996) The effect of tourniquet use in anterior cruciate ligament reconstruction. A prospective, randomized study. Am J Sports Med 24:758–764

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Bould M, Freeman BJC, Pullyblank A, Newman JH (1998) Blood loss in sequential bilateral total knee arthroplasty. J Arthroplasty 13:77–79

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Burkart BC, Bourne RB, Rorabeck CH, Kirk PG, Nott L (1994) The efficacy of tourniquet release in blood conservation after total knee arthroplasty. Clin Orthop Relat Res 299:147–152

    PubMed  Google Scholar 

  6. 6.

    Cheng YJ, Wang YP, Chien CT, Chen CF (2002) Small-dose propofol sedation attenuates the formation of reactive oxygen species in tourniquet-induced ischaemia- reperfusion injury under spinal anesthesia. Anesth Analg 94:1617–1620

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Daniel DM, Lumkong G, Stone MS, Pedowitz RA (1995) Effects of tourniquet use in anterior cruciate ligament reconstruction. Arthroscopy 11:307–311

    PubMed  CAS  Article  Google Scholar 

  8. 8.

    Dobner JJ, Nitz AJ (1982) Postmeniscectomy tourniquet palsy and functional sequelae. Am J Sports Med 10:211–214

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Graf B, Jensen K, Orwin J et al (1996) The effect of tourniquet use on postoperative strength recovery after arthroscopic menisectomy. Orthopaedics 19:497–500

    CAS  Google Scholar 

  10. 10.

    Graham B, Breault MJ, McEwen JA, McGraw RW (1993) Occlusion of arterial flow in the extremities at subsystolic pressures through the use of wide tourniquet cuffs. Clin Orthop Relat Res 286:257–261

    PubMed  Google Scholar 

  11. 11.

    Guanche CA (1995) Tourniquet- induced tibial nerve palsy complicating anterior cruciate ligament reconstruction. Arthroscopy 11:620–622

    PubMed  CAS  Google Scholar 

  12. 12.

    Hiippala ST, Strid LJ, Wennerstrand MI et al (1997) Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty. Anesth Analg 84:839–844

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Iorio R, Healy WL (2001) Tourniquet use during total knee arthroplasty did not reduce total blood loss. J Bone Joint Surg Am 83:1282

    PubMed  Google Scholar 

  14. 14.

    Ishii Y, Matsuda Y (2005) Effect of tourniquet pressure on perioperative blood loss associated with cementless total knee arthroplasty: a prospective, randomized study. J Arthroplasty 20:325–330

    PubMed  Article  Google Scholar 

  15. 15.

    Jarolem KL, Scott DF, Jaffe WL et al (1995) A comparison of blood loss and transfusion requirements in total knee arthroplasty with and without arterial tourniquet. Am J Orthop 24:906–909

    PubMed  CAS  Google Scholar 

  16. 16.

    Lefer AM, Lefer DJ (1996) The role of nitric oxide and cell adhesion molecules on the microcirculation in ischaemia-reperfusion. Cardiovasc Res 32:743–751

    PubMed  CAS  Google Scholar 

  17. 17.

    Marson BM, Tokish JT (1999) The effect of a tourniquet on intraoperative patellofemoral tracking during total knee arthroplasty. J Arthroplasty 14:197–199

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Moore MR, Garfin SR, Hargens AR (1987) Wide tourniquets eliminate blood flow at low inflation pressures. J Hand Surg [Am] 12:1006–1011

    CAS  Google Scholar 

  19. 19.

    Muirhead A, Newman RJ (1986) A low-pressure tourniquet system for the lower limb. Injury 17:53–54

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Mylod AG Jr, France MP, Muser DE, Parsons JR (1990) Perioperative blood loss associated with total knee arthroplasty. J Bone Joint Surg Am 72:1010–1012

    PubMed  Google Scholar 

  21. 21.

    Neimkin RJ, Smith RJ (1983) Double tourniquet with linked mercury manometers for hand surgery. J Hand Surg [Am] 8:938–941

    CAS  Google Scholar 

  22. 22.

    Newman RJ, Muirhead A (1986) A safe and effective low-pressure tourniquet: a prospective evaluation. J Bone Joint Surg Br 68:625–628

    PubMed  CAS  Google Scholar 

  23. 23.

    Odinsson A, Finsen V (2006) Tourniquet use and its complications in Norway. J Bone Joint Surg Br 88:1090–1092

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Oxman T, Arad M, Klein R, Avazov N, Rabinowitz B (1997) Limb ischaemia preconditions the heart against reperfusion tachyarrhythmia. Am J Physiol 273:1707–1712

    Google Scholar 

  25. 25.

    Parmet JL, Horrow JC, Berman AT (1998) The incidence of large venous emboli during total knee arthroplasty without tourniquet use. Anesth Analg 87:439–444

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Pauers RS, Carocci MA (1994) Low pressure pneumatic tourniquets: effectiveness at minimum recommended inflation pressures. J Foot Ankle Surg 33:605–609

    PubMed  CAS  Google Scholar 

  27. 27.

    Reid HS, Camp RA, Jacob WH (1983) Tourniquet hemostasis. A clinical study. Clin Orthop Relat Res 177:230–234

    PubMed  Google Scholar 

  28. 28.

    Sherman OH, Fox JM, Snyder SJ et al (1986) Arthroscopy: “no problem surgery”: Analysis of complications in two thousand six hundred and forty cases. J Bone Joint Surg Am 68:256–265

    PubMed  CAS  Google Scholar 

  29. 29.

    Tejwani NC, Immerman I, Achan P, Egol KA, McLaurin T (2006) Tourniquet cuff pressure: the gulf between science and practice. J Trauma 61:1415–1418

    PubMed  Article  Google Scholar 

  30. 30.

    Tuncali B, Karci A, Bacakoglu AK, Tuncali BE, Ekin A (2003) Controlled hypotension and minimal inflation pressure: a new approach for pneumatic tourniquet application in upper limb surgery. Anesth Analg 97:1529–1532

    PubMed  Article  Google Scholar 

  31. 31.

    Vandenbussche E, Duranthon LD, Couturier M, Pidhorz L, Augereau B (2002) The effect of tourniquet use in total knee arthroplasty. Int Orthop 26:306–309

    PubMed  Article  Google Scholar 

  32. 32.

    Wauke K, Nagashima M, Kato N, Ogawa R, Yoshino S (2002) Comparative study between thromboembolism and total knee arthroplasty with and without tourniquet in rheumatoid arthritis patients. Arch Orthop Trauma Surg 122:442–446

    PubMed  Google Scholar 

  33. 33.

    Worland RL, Arrendondo J, Angeles F, Lopez-Jimenez F, Jessup DE (1997) Thigh pain following tourniquet application in simultaneous bilateral total knee replacement arthroplasty. J Arthroplasty 12:848–852

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Younger AS, McEwen JA, Inkpen K (2004) Wide countered thigh cuffs and automated limb occlusion measurement allow lower tourniquet pressures. Clin Orthop 428:286–293

    PubMed  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Yoshinori Ishii.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ishii, Y., Noguchi, H., Takeda, M. et al. A new tourniquet system that determines pressures in synchrony with systolic blood pressure in knee surgery. Knee Surg Sports Traumatol Arthr 17, 48–52 (2009). https://doi.org/10.1007/s00167-008-0640-9

Download citation


  • Tourniquet
  • Systolic blood pressure
  • Knee surgery