The use of an intraoperative tourniquet for total knee arthroplasty (TKA) is a common practice. Although it provides clear filed and ideal cementation during surgery, issues regarding the effectiveness, drawbacks and complications are still investigated. This review was conducted to evaluate the role of tourniquet in TKA through a comprehensive literature search was done in PubMed Medicine, Embase, and other internet database. Debating issues, including the blood loss, operation time, alignment, compromised wound healing, quadriceps weakness and timing of release were furtherly examined. Based on our prior work and the general consensus that the tourniquet should be set with the lowest pressure and for the least ischemic time possible, we recommend early tourniquet release right after the closure of extensor mechanism in the TKAs without drainage.

A Fast-track (FT) program, a well-established approach for patients undergoing selective operations, aims at enhanced post-operative recovery. It was first introduced by Professor Henrik Kehlet in 1990s and was applied in colorectal surgery. With the increasing elderly population as well as the increasing incidence of osteoarthritis, the rapid growth of requirement of joint arthroplasties is to be expected. Therefore, many orthopedic teams have applied related principles to their daily practice of total knee arthroplasty to accelerate rehabilitation with lower mortality and morbidity, and to optimize patient satisfaction. The program is a multimodal and multidisciplinary standardized care. Various caring specialties are involved to fulfill the goals of the fast-track program; the basic members include anesthetists, surgeons, pain specialist, physiotherapists, nurses and even medical physicians. In general, the strategy consists of five strands: careful patient selection, improving preoperative care, minimizing perioperative stresses, decreasing postoperative discomfort, and improving postoperative recovery. Through full understanding of these strands and concepts, a comprehensive, perioperative care is thus constructed. This review article gives reader an overall concept of fast track surgery in total knee replacement surgery. A comprehensive search in English literature, including case series, associate randomized controlled trials and systematic reviews were performed using the PubMed databases in 2017 December.