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Reappraisal of Limited Duration Tourniquet in Total Knee Arthroplasty: A Double-Blinded RCT



The majority of arthroplasty surgeons use a full duration of tourniquet while doing total knee arthroplasty. Recent literature suggests clinical dilemma about superior function with limited duration use of a tourniquet. The purpose of this study is to evaluate the time-dependent effects and clinical outcome of tourniquet in patients undergoing total knee arthroplasty (TKA) and to assess the incidence of adverse vascular events of the limb in TKA. This study is the first of its kind to evaluate all the serious vascular events prospectively.


Sixty participants who underwent TKA in the duration of 1.5 years at a large single tertiary care centre were recruited and randomly allocated in two groups: Full duration tourniquet (n = 30) and tourniquet only during cementation (n = 30). All patients underwent preoperative and postoperative arterial and venous Doppler to evaluate the presence of thrombosis. The operative duration, blood loss, and clinical outcome (visual analogue scale, active knee range of motion, Knee Society score, and duration of stay) were recorded.


The incidence of vascular complications was not statistically significant in either group (P = 0.99). Tourniquet during cementation only group exhibited decreased postoperative pain on days 1, 2, and 3 (P < 0.01). But postoperative knee active range of motion was the same between the two groups with no significant postoperative complications.


Tourniquet use only during cementation could result in faster recovery and less pain during the early rehabilitation period with no influence over the incidence of serious vascular events.

Trial Registry Number

AIIMS/IEC/2018/475. This study was approved by the Research Ethics Committee at All India Institute of Medical Sciences, Jodhpur and was carried out at AIIMS (Jodhpur), India.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information




JN did preoperative evaluation, enrolled patients, randomisation, participated in the design of the study, performed statistical analyses, and wrote the manuscript. AE and SB coordinated and did the surgeries and contributed in writing the manuscript. AE and SB have reviewed and analysed the data and attest to the integrity of the original data reported in this manuscript. PKG did the preoperative and postoperative radiological evaluation of the patients in this study.

Corresponding author

Correspondence to Abhay Elhence.

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The authors declare that they have no conflict of interest.

Ethics Approval

The study was performed only after the approval of the Research Ethics Committee (AIIMS/IEC/2018/475).

Informed Consent

For this study informed consent was obtainted from the participants.

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Netaji, J., Banerjee, S., Garg, P.K. et al. Reappraisal of Limited Duration Tourniquet in Total Knee Arthroplasty: A Double-Blinded RCT. JOIO 55, 1186–1194 (2021).

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  • Total knee arthroplasty
  • Tourniquet
  • DVT
  • Arterial thrombosis