Tourniquet use in TKA is common practice. A recent meta-analysis concluded that whilst early release (prior to closure of the quadriceps mechanism) increases blood loss, it protects patients from complications. However, there has been no research evaluating tourniquet use during cement fixation only. This study proposed to establish whether tourniquet application during cement fixation only (Short Duration) was associated with better functional recovery compared to standard tourniquet (Long Duration) application during TKA.

We planned to randomise 230 patients to receive Short or Long Duration tourniquet application. The primary outcomes were in-hospital donor transfusion rate and the Oxford Knee Score at 10 weeks post-surgery. Serial measures (pre-operative, day 4 then 2, 10, 26 and 52 weeks post-operation) of knee range and function were undertaken. Pre- and post-operative Doppler ultrasounds were obtained. The trial was discontinued after randomisation of 65 patients.

Interim analysis indicated the risk of transfusion (odds ratio 7.38, P = 0.015) was higher in the Short Duration group. At 10 weeks post-surgery, no significant difference was observed in Oxford Knee Score. There were no between-group differences in rate of recovery up to 26 weeks for any outcome.

We conclude that restricting tourniquet application to the period of cementing is associated with a significantly higher risk of transfusion. This approach is impractical if it is not offset by very impressive gains in functional recovery.