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

Abstract

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.

Reply to Letter to the Editor

“…Blood loss in patients with a tourniquet for cementation only was a mean 1795 mL compared to our mean 574 mL. The study by Kvedaras et al [5] is well designed -preoperative medications (including alcohol) were factored into patient inclusion into the study. Results of the study showed a mean operative tourniquet time of 37 minutes versus our mean of 43 minutes.…”

“…Two studies [5,8] comparing operative tourniquet use with cementation tourniquet were published in parallel with ours. Therefore, we did not discover them with our literature search.…”

“…Consequently, their data is more specific for the correct number. Kvedaras et al [5] had a third group with an inflated tourniquet at a mean of 60 minutes. This group had greater volume of blood loss and greater loss of red blood cells, but was not different from the tourniquet time of 38 minutes when body weight was included in the calculation.…”

Letter to the Editor

“…Although the authors mentioned that there were no previous studies comparing the effects of tourniquet used only during cementing, we found two studies on the same topic published before the current study [4,7]. Kvederas and colleagues [4] compared three groups undergoing TKA in a Level II study.…”

“…Kvederas and colleagues [4] compared three groups undergoing TKA in a Level II study. In the first group, the tourniquet was inflated before incision and deflated after hardening of the cement.…”