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Background: Although tourniquets are widely used in total knee arthroplasty, their effectiveness in reducing blood loss and their influence on the postoperative course remain unclear. Tourniquet-related soft-tissue damage is a related concern. We performed a prospective, randomized, controlled trial to clarify the effect of tourniquets in total knee arthroplasty.

Methods: Seventy-two patients undergoing total knee arthroplasty were randomly allocated to a tourniquet or non-tourniquet group. Blood loss and changes in C-reactive protein, creatine phosphokinase, and other indicators of soft-tissue damage were monitored preoperatively and postoperatively on Days 1, 2, and 4. Thigh pain, knee pain, limb swelling, rehabilitation progress, and hospital stays were also recorded for comparison.

Results: Patients in the tourniquet group showed smaller decreases in hemoglobin (mean and standard deviation, 2.6 /- 0.9 versus 3.7 /- 1.3 g/dL) and hematocrit (7.6% /- 2.8% versus 10.4% /- 4.0%), less calculated blood loss (303 /- 119 versus 423 /- 197 mL), and smaller increases in C-reactive protein (peak value, 175 /- 55 versus 139 /- 75 mg/dL) and creatine phosphokinase (peak value, 214 /- 89 versus 162 /- 104 U/L) compared with those in the non-tourniquet group. There was slightly less postoperative pain in the non-tourniquet group. There were no significant differences between the groups in terms of swelling, rehabilitation progress, or hospital stays.

Conclusions: The use of a tourniquet during total knee arthroplasty was effective for reducing blood loss and avoiding excessive postoperative inflammation and muscle damage. The use of a tourniquet was related to slightly more postoperative pain but did not affect postoperative recovery.

Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Copyright 2012 by The Journal of Bone and Joint Surgery, Incorporated