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Tourniquet application only during cement fixation in total knee arthroplasty: a double-blind, randomized controlled
Rajat Mittal1, Victoria Ko, Sam Adie
1South Western Sydney Local Health Network, Orthopaedic Department, Liverpool Hospital, Liverpool, NSW 1871, Australia. rajatmittal.syd@gmail.com
Background:
The functional benefits of tourniquet application for short periods compared with standard duration applications during total knee arthroplasty surgery have not been well explored. We aimed to compare functional outcomes between tourniquet application of short duration (during cement fixation only) and tourniquet application of longer duration (from skin incision to just after cement fixation).
Methods:
We planned to randomize 230 patients to short and long duration groups. The primary outcome was Oxford Knee Score at 10 weeks post-surgery. In-hospital blood transfusion rate was also a primary safety measure. Serial measures of knee function were taken together with knee range, quadriceps lag and timed stair tests.
Results:
The trial was discontinued after randomization of 65 patients. Interim analysis indicated a higher risk of transfusion (odds ratio 7.38, P= 0.015) in the short duration group. No significant difference was observed in Oxford Knee Score at 10 weeks. There were no between-group differences in rate of recovery up to 52 weeks for any outcome.
Conclusions:
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 gains in functional recovery.