The effects of a pneumatic tourniquet on blood loss in total knee arthroplasty.

OBJECTIVE

In lower-extremity surgery there are significant risks associated with the use of tourniquets. This prospective study was done to assess to what extent these risks may be offset by the potential advantages of tourniquets, namely reductions in blood loss, length of hospital stay and complication rates.

DESIGN

A prospective case study.

SETTING

A major urban hospital.

PATIENTS

Sixty-three consecutive patients scheduled for primary cemented total knee arthroplasty (TKA) were blindly randomized into tourniqet (n = 33) and non-tourniquet (n = 30) groups.

INTERVENTION

TKA during which a pneumatic tourniquet was applied or not applied to control blood loss.

MAIN OUTCOME MEASURES

Perioperative blood loss, operating time, complication rates, hospital stay and transfusion needs.

RESULTS

Differences in the total measured blood loss, intraoperative blood loss and the Hemovac drainage blood loss between the 2 groups were not significantly different (p > 0.25). The calculated total blood loss was actually lower in the non-tourniquet group (p = 0.02). Between the groups there were no statistical differences in surgical time, length of hospital stay, transfusion requirements or rate of complications (although there was a trend to more complications in the tourniquet group (p = 0.06)).

CONCLUSION

The effectiveness of a pneumatic tourniquet to control blood loss in TKA is questionable.