TKA sans tourniquet: let it bleed: opposes

The literature supports the routine use of a tourniquet during total knee arthroplasty (TKA). With tourniquet use, there is decreased intraoperative blood loss with subsequent improved visibility and a bloodless surgical field. This facilitates efficiency with the potential for decreased operating time. Increased operating time has been associated with an increase in the incidence of infection after TKA. Opponents of routine tourniquet use cite rare or theoretical concerns. Multiple authors have concluded that the incidence of deep vein thrombosis is not related to using a tourniquet. The rare events of muscle dysfunction or nerve injury are transient. Peripheral vascular disease, in which patients have no palpable distal pulses, should be considered a possible contraindication to the use of a tourniquet during TKA. If tourniquet time and pressure are respected during TKA, we believe the benefits outweigh the perceived and theoretical concerns.