Abstract
Total knee arthroplasty is an operation that can be performed with or without the use of tourniquet. Two systematic reviews and meta-analyses of the available literature have demonstrated that the use of tourniquet leads to a reduction in blood loss and also shortens the operative time. The opponents for use of tourniquet cite development of complications such as skin bruising, neurovascular injury, and metabolic disturbances as a deterrent for the use of tourniquet. Although the latter may be true for some patients such as those with previous vascular grafts, there is little evidence that routine use of tourniquet during TKA results in any of the above complications. The use of tourniquet on the other hand provides a bloodless field that allows the surgeon to perform the procedure with expediency and optimised visualisation. Blood conservation has gained extreme importance in recent years because of increased understanding of problems associated with blood transfusion such as increased surgical site infection (due to immunomodulation effect), increased length of hospital stay, increased cost and so on. Based on our understanding of the available evidence, we believe that routine use of tourniquet during TKA is justified and a good surgical practice.
