Comparing Sequential vs Simultaneous Tourniquet Inflation in Bilateral Total Knee Arthroplasty

Area of Science:

• Orthopedic Surgery
• Anesthesiology
• Surgical Outcomes

Background:

• Limited evidence exists on tourniquet use during bilateral total knee arthroplasty (BTKA).
• Tourniquet application impacts postoperative outcomes and operating room efficiency.
• This study evaluates simultaneous tourniquet inflation in BTKA.

Purpose of the Study:

• To assess the safety and efficacy of simultaneous tourniquet inflation during BTKA.
• To compare simultaneous versus sequential tourniquet inflation in terms of patient outcomes and surgical efficiency.
• To determine if simultaneous tourniquet use is noninferior to sequential use.

Main Methods:

• Retrospective review of 285 BTKA patients (March 2013-May 2018).
• Two cohorts: simultaneous tourniquet inflation versus sequential inflation.
• Collected perioperative variables and tracked complications for 90 days post-surgery.

Main Results:

• Simultaneous cohort showed higher ASA class and smoker rates.
• Significantly lower tourniquet time, delta hemoglobin, and surgical time in the simultaneous group.
• Noninferiority demonstrated for thrombotic, respiratory, and soft tissue/wound complication categories.

Conclusions:

• Simultaneous tourniquet inflation is noninferior to sequential inflation in BTKA.
• Consider sequential inflation or staged TKA for patients with cardiac history.
• Findings support safe and efficient BTKA procedures using simultaneous tourniquet inflation.