Early release of tourniquet in total knee arthroplasty: Is it worthwhile?

To compare the effects of duration and timing of tourniquet release on perioperative blood loss, transfusion requirement, duration of surgery, length of hospital stay and early complications in total knee arthroplastywith and without additional anti-fibrinolytic therapy.

The prospective quasi-experimental study was conducted at the Combined Military Hospital, Rawalpindi, from March to August 2014. The patients undergoing total knee arthroplasty were divided into two groups: in Group A tourniquet was released after closure of surgical wound and applying compressive dressing; and in Group-B tourniquet was deflated after cementation of implants following which closure was done. Each group was further divided into those who received tranexamic acid (A-T, B-T) and those who did not (A-C, B-C). Study variables were noted on a proforma and analysed.

Of the 75 patients in the study, 27(36%) were male and 48(64%) were females. Calculated blood loss was 408mL and 422mL in group A-T and B-T respectively (p=0.73), and 615mL and 610mL in group A-C and B-C respectively (p=0.95). Tourniquet time was significantly shorter (p<0.0005) in group B whereas duration of surgery was significantly shorter (p<0.0001) in group A (68±9min vs 77±11min). Transfusion frequency was higher in group B. Complication rate in the two main groups was not significantly different (p=0.314). Mean length of hospital stay was not significantly different (p>0.05).

Earlier intra-operative release of tourniquet in patients undergoing total knee arthroplasty was associated with increased surgery time and higher frequency of blood transfusion without conferring any significant benefit.