Traditional use of tourniquets and reinfusion drains in total knee replacement (TKR) has recently been challenged. Many studies have challenged the benefits of their use. Our aim was to compare the outcomes of three different blood management techniques in primary TKR.

We conducted a prospective randomised study of 87 patients with a mean age of 71 years. All patients were randomised into three groups: Group A (29 patients without tourniquet and drain), Group B (27 patients without tourniquet or drain but cell salvage system) and Group C (31 patients with the use of tourniquet and drain).

The results showed no difference between the postoperative haemoglobin drop and blood transfusion rate between the groups. At day two, range of knee movements (Group A: 80.2 degree; Group B: 79.6 degree; Group C: 77.9 degree) showed no significant difference. Two Group C patients (6.4%) had postoperative thromboembolic events (one DVT, one TIA). Knee stiffness leading to readmission (Group A: 6.8%; Group B: 7.4%; Group C: 3.2%) and superficial wound problems did not reveal any significant difference. The average operative time and hospital stay were the same in all groups and there was no wound haematoma or deep infection in any groups.

There was no statistical difference between the groups for any outcome measure assessed thus the use of tourniquets and drains in total knee arthroplasty are controversial and questionable. We can conclude that all techniques are safe and it is the surgeon's choice as to which they apply routinely in their clinical practice.