Abstract
During TKA, a surgeon has 4 options: not to use a tourniquet at all, use it from incision to closure, from incision until cementing, and only during cementing. The potential advantages of using a tourniquet are: to reduce blood loss, to have a clear operative field, to facilitate preparation of bony surfaces that are optimal for cementation and longevity of fixation of implants, and to reduce the potential for blood-borne disease transmission through needlestick injuries. Potential disadvantages of tourniquet use have been outlined by the previous speaker. In particular, using a tourniquet from incision until closure has several disadvantages and is generally not a preferred option.
While this paper opposes tourniquetless TKA, it supports using a tourniquet from incision until cementing. We will present in support the findings of our prospective, randomised, double-blind study in patients undergoing cemented, navigated, bilateral simultaneous TKA wherein a tourniquet was used from incision until cementing was complete on one side and compared with the other knee in which a tourniquet was used only during cementing. We compared knee pain, thigh pain, blood loss, hemodynamic changes, functional outcome and complications. We concluded that total knee arthroplasty can be safely and effectively performed with the use of the tourniquet from skin incision until cementing without adverse effects.
