Is lower tourniquet pressure during total knee arthroplasty effective? A prospective randomized controlled trial

Tae Kyun Kim, Ankur B Bamne, Jae Ang Sim, Ji Hyeon Park, Young Gon Na, Tae Kyun Kim, Ankur B Bamne, Jae Ang Sim, Ji Hyeon Park, Young Gon Na

Abstract

Background: Higher tourniquet pressures may be associated with an increased risk of complications. We aimed to determine (1) whether a lower tourniquet pressure [systolic blood pressure (SBP) + 120 mmHg] is as effective as conventional tourniquet pressure (SBP + 150 mmHg) in providing a bloodless surgical field and decreasing blood loss, and (2) whether lowering the tourniquet pressure decreases tourniquet-related complications compared to conventional inflation pressure.

Methods: One hundred and sixty knees in 124 patients undergoing total knee arthroplasty (TKA) were randomly allocated to either conventional (n = 80) or lower inflation pressure group (n = 80). The quality of the initial surgical field and occurrence of intraoperative blood oozing, hemoglobin drop, drained volume and calculated blood loss were assessed as efficacy variables. Safety outcome variables included post-operative pain, tourniquet site skin problems (ecchymosis, bullae, skin necrosis), and other tourniquet-related complications such as nerve palsy, venous thromboembolism, and delayed rehabilitation.

Results: A comparable bloodless surgical field was successfully provided in both groups (100% vs. 99%, p = 1.000). One case in the conventional pressure group and two cases in the lower pressure group showed intraoperative blood oozing (p = 1.000), which was successfully controlled after an increase of 30 mmHg in the tourniquet inflation pressure. There was no difference in the hemoglobin drop, drained volume, and calculated blood loss. The two groups did not differ in any safety outcomes such as post-operative pain, thigh complications, and other tourniquet related complications.

Conclusion: This study demonstrates that a tourniquet inflation pressure of 120 mmHg above the SBP is effective method during TKA.

Trial registration: The trial was with ClinicalTrials.gov ( NCT01993758 ) on November 25, 2013.

Keywords: Arthroplasty; Complication; Inflation pressure; Knee; Tourniquet.

Conflict of interest statement

One of the authors (TKK) received research funding from Smith & Nephew and B. Braun Aesculap, and is a design consultant for Smith & Nephew and B. Braun Aesculap. None of the other authors (ABB, JAS, JHP, YGN) have relevant conflicts of interest to declare.

Each author certifies that his or her institution has approved the human protocol for this.

Investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained.

One of the authors (TKK) received research funding from Smith & Nephew and B. Braun Aesculap, and is a design consultant for Smith & Nephew and B. Braun Aesculap. None of the other authors (ABB, JAS, JHP, YGN) have relevant conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Flowchart showing enrollment of patients

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