2015 AAOS Annual Meeting: How Can We Use Tourniquet More Properly During Total Knee Arthroplasty?

This trial conducted randomized sub-studies on patients undergoing total knee arthroplasty with a pneumatic tourniquet. The first study randomized 160 patients to the use of either low (SBP + 120 mmHg) or high (SBP + 150 mmHg) tourniquet pressures with the purpose of quantifying an effective and safe tourniquet pressure. Following the intraoperative assessment of the quality of the surgical field, and other safety parameters, it was indicated that low tourniquet pressure (SBP + 120 mmHg) can be safely applied post-anesthesia. The second study randomized 206 patients to a deflation group, where deflation was maintained following early tourniquet release, or reinflation group, where the tourniquet was reinflated following its early release. This sub-study aimed to investigate the effectiveness and safety of reinflating the tourniquet following its early release, as opposed to simply releasing it, when considering site visualization, operative time, and complications. The results of this trial delineated that surgical field visualization was improved in the reinflation group, though operative time, incidence of complications and postoperative blood loss were unaffected up to 5 days following the procedure.