R. Mittal BSc (Med), MBBS, MMed (Clin Epi); V. Ko. BAppSc (Phty) (Hons); S. Adie BSc (Med), MBBS, MSpMed, MPH; J. Naylor BAppSc (Phty), PhD; J. Dave MBBS, FRACS (Ortho); C. Dave MBBS, FRACS (Ortho); I. A. Harris MBBS, MMed (Clin Epi), FRACS (Ortho), PhD; D. Hackett M Phty, BAppSc (Ex & Sp Sc); D. Ngo BAppSc (Phty); S. Dietsch BHlthSc (Nurs), DipAppSci (Nurs), GC Nurs (Ortho).
Tourniquet application only during cement fixation in total knee arthroplasty: a double-blind, randomized controlled trial
Article first published online: 10 MAY 2012
© 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons
ANZ Journal of Surgery
Volume 82, Issue 6, pages 428–433, June 2012
How to Cite
Mittal, R., Ko, V., Adie, S., Naylor, J., Dave, J., Dave, C., Harris, I. A., Hackett, D., Ngo, D. and Dietsch, S. (2012), Tourniquet application only during cement fixation in total knee arthroplasty: a double-blind, randomized controlled trial. ANZ Journal of Surgery, 82: 428–433. doi: 10.1111/j.1445-2197.2012.06083.x
- Issue published online: 3 JUN 2012
- Article first published online: 10 MAY 2012
- Accepted for publication 11 October 2011.
- randomized controlled trial
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.