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

Objective: In lower-extremity surgery there are significant risks associate d 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 tourn iquets, namely reductions in blood loss, length of hospital stay and compli cation rates. Design: A prospective case study. Setting: A major urban hosp ital. Patients: Sixty-three consecutive patients scheduled for primary ceme nted total knee arthroplasty (TI(A)were blindly randomized into tourniqet ( n = 33) and non-tourniquet (n = 30) groups. Intervention: TI(A. during whic h a pneumatic tourniquet was applied or not applied to control blood loss. Main outcome measures: Perioperative blood loss, operating time, complicati on rates, hospital stay and transfusion needs. Results: Differences in the total measured blood loss, intraoperative blood loss and the Hemovac draina ge blood loss between the 2 groups were not significantly different (p > 0. 25). The calculated total blood loss was actually lower in the non-tourniqu et group (p = 0.02). Between the groups there were no statistical differenc es in surgical time, length of hospital stay, transfusion requirements or r ate of complications (although there was a trend to more complications in t he tourniquet group (P = 0.06)). Conclusion: The effectiveness of a pneumat ic tourniquet to control blood loss in TKA is questionable.