Tourniquet Use is Associated with Reduced Blood Loss and Fewer Reoperations in Aseptic Revision Total Knee Arthroplasty

Published:January 10, 2022DOI:



      Although tourniquet use in primary total knee arthroplasty (TKA) has been widely studied, the outcomes associated with tourniquet use in revision TKA (rTKA) remains relatively unexplored. This study investigates surgical outcomes and patient satisfaction in association with tourniquet use during aseptic rTKA.


      We retrospectively reviewed all patients who underwent rTKA for aseptic causes at our institution from 2011-2020. Patients were separated into two cohorts based on tourniquet inflation during the procedure. Outcomes of interest included estimated blood loss (EBL), change in hemoglobin (Hb), surgical time, length-of-stay (LOS), reoperation rate, and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS,JR) scores.


      Of the 1,212 patients included, 1,007 (83%) underwent aseptic rTKA with the use of a tourniquet and 205 (17%) without the use of a tourniquet. The mean tourniquet inflation time was 93.0 minutes (SD:33.3 minutes). Blood loss was significantly less for patients in the tourniquet cohort as measured through EBL(224.1vs.325.1 mL,p<0.001) and change in preoperative to postoperative Hb(1.75vs.2.04 g/dL,p<0.001). There were no statistical differences in surgical time(p=0.267) and LOS(p=0.206) between the two groups. The reoperation rate was significantly greater for patients who did not have a tourniquet utilized (20.5%vs.15.0%,p=0.038). Delta improvement in KOOS,JR scores from baseline to 3-months postoperatively did not statistically differ between the two cohorts (p=0.560).


      While delta improvements in KOOS,JR scores were similar for both cohorts, patients who did not have a tourniquet inflated during aseptic rTKA had increased blood loss and were more likely to undergo subsequent reoperation compared to patients who did.


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      1. Varacallo M, Johanson NA. Total Knee Arthroplasty (TKA) Techniques. 2018.

        • Goel R.
        • Rondon A.J.
        • Sydnor K.
        • Blevins K.
        • O’Malley M.
        • Purtill J.J.
        • et al.
        Tourniquet Use Does Not Affect Functional Outcomes or Pain After Total Knee Arthroplasty: A Prospective, Double-Blinded, Randomized Controlled Trial.
        J Bone Joint Surg Am. 2019; 101: 1821-1828
        • Feng J.E.
        • Novikov D.
        • Anoushiravani A.A.
        • Schwarzkopf R.
        Total knee arthroplasty: improving outcomes with a multidisciplinary approach.
        J Multidiscip Healthc. 2018; 11: 63-73
        • Jawhar A.
        • Skeirek D.
        • Stetzelberger V.
        • Obertacke U.
        Influence of the Tourniquet on Pain and Function in Total Knee Arthroplasty: a Systematic Review and Meta-Analysis.
        Z Orthop Unfall. 2020; 158: 630-640
        • Jawhar A.
        • Skeirek D.
        • Stetzelberger V.
        • Kollowa K.
        • Obertacke U.
        No effect of tourniquet in primary total knee arthroplasty on muscle strength, functional outcome, patient satisfaction and health status: a randomized clinical trial. Knee Surgery.
        Sport Traumatol Arthrosc. 2020; 28: 1045-1054
        • Zhang Q.
        • Dong J.
        • Gong K.
        • Li X.
        • Zheng S.
        • Wen T.
        Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016; 30: 421-425
        • Ryu K.J.
        CORR Insights ® : Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial.
        Clin Orthop Relat Res. 2016; 474: 78-80
        • Arthur J.R.
        • Spangehl M.J.
        Tourniquet Use in Total Knee Arthroplasty.
        J Knee Surg. 2019; 32: 719-729
        • Tai T.-W.
        • Lin C.-J.
        • Jou I.-M.
        • Chang C.-W.
        • Lai K.-A.
        • Yang C.-Y.
        Tourniquet use in total knee arthroplasty: a meta-analysis.
        Knee Surgery, Sport Traumatol Arthrosc. 2011; 19: 1121-1130
        • Liu D.
        • Graham D.
        • Gillies K.
        • Gillies R.M.
        Effects of Tourniquet Use on Quadriceps Function and Pain in Total Knee Arthroplasty.
        Knee Surg Relat Res. 2014; 26: 207-213
        • Dennis D.A.
        • Kittelson A.J.
        • Yang C.C.
        • Miner T.M.
        • Kim R.H.
        • Stevens-Lapsley J.E.
        Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial.
        Clin Orthop Relat Res. 2016; 474: 69-77
        • Parvizi J.
        • Diaz-Ledezma C.
        Total knee replacement with the use of a tourniquet.
        Bone Joint J. 2013; 95-B: 133-134
        • Abdel M.P.
        • Berry D.J.
        Current Practice Trends in Primary Hip and Knee Arthroplasties Among Members of the American Association of Hip and Knee Surgeons: A Long-Term Update.
        J Arthroplasty. 2019; 34: S24-S27
        • Gabor J.A.
        • Padilla J.A.
        • Feng J.E.
        • Anoushiravani A.A.
        • Slover J.
        • Schwarzkopf R.
        A dedicated revision total knee service.
        Bone Joint J. 2019; 101-B: 675-681
        • Lyman S.
        • Lee Y.Y.
        • Franklin P.D.
        • Li W.
        • Cross M.B.
        • Padgett D.E.
        Validation of the KOOS, JR: A Short-form Knee Arthroplasty Outcomes Survey.
        Clin Orthop Relat Res. 2016; 474: 1461-1471
        • Bosch L.C.
        • Beger S.B.
        • Duncan S.T.
        • Rossi S.M.P.
        • Sculco P.K.
        • Barnes C.L.
        • et al.
        Intraoperative Practice Variability in Total Knee Arthroplasty.
        J Arthroplasty. 2020; 35: 725-731
        • Rama K.R.B.S.
        • Apsingi S.
        • Poovali S.
        • Jetti A.
        Timing of Tourniquet Release in Knee Arthroplasty.
        J Bone Jt Surg. 2007; 89: 699-705
        • Huang Z.Y.
        • Pei F.X.
        • Ma J.
        • Yang J.
        • Zhou Z.K.
        • Kang P De
        • et al.
        Comparison of three different tourniquet application strategies for minimally invasive total knee arthroplasty: a prospective non-randomized clinical trial.
        Arch Orthop Trauma Surg. 2014; 134: 561-570
        • Alcelik I.
        • Pollock R.D.
        • Sukeik M.
        • Bettany-Saltikov J.
        • Armstrong P.M.
        • Fismer P.
        A Comparison of Outcomes With and Without a Tourniquet in Total Knee Arthroplasty.
        J Arthroplasty. 2012; 27: 331-340
        • Jiang F.
        • Zhong H.
        • Hong Y.
        • Zhao G.
        Use of a tourniquet in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials.
        J Orthop Sci. 2015; 20: 110-123
        • Chaudhry E.A.
        • Aziz A.
        • Faraz A.
        • Iqbal M.
        • Tarar M.Y.
        • Rizvi S.H.M.
        • et al.
        Applicsation of Tourniquet Does Not Influence Early Clinical Outcomes After Total Knee Arthroplasty.
        Cureus. 2021;
        • Cai D.F.
        • Fan Q.H.
        • Zhong H.H.
        • Peng S.
        • Song H.
        The effects of tourniquet use on blood loss in primary total knee arthroplasty for patients with osteoarthritis: A meta-analysis.
        J Orthop Surg Res. 2019; 14: 348
        • Tirumala V.
        • Klemt C.
        • Oganseyan R.
        • Walker P.
        • Padmanabha A.
        • Kwon Y.-M.
        Outcomes of Tourniquet-Less Revision Total Knee Arthroplasty: A Matched Cohort Analysis.
        J Am Acad Orthop Surg. 2021; (Publish Ah)
        • Alexandersson M.
        • Wang E.Y.
        • Eriksson S.
        A small difference in recovery between total knee arthroplasty with and without tourniquet use the first 3 months after surgery: a randomized controlled study.
        Knee Surgery, Sport Traumatol Arthrosc. 2019; 27: 1035-1042
        • Ahmed I.
        • Chawla A.
        • Underwood M.
        • Price A.J.
        • Metcalfe A.
        • Hutchinson C.
        • et al.
        Tourniquet use for knee replacement surgery.
        Cochrane Database Syst Rev. 2017;
        • Zak S.G.
        • Yeroushalmi D.
        • Long W.J.
        • Meftah M.
        • Schnaser E.
        • Schwarzkopf R.
        Does the Use of a Tourniquet Influence Outcomes in Total Knee Arthroplasty: A Randomized Controlled Trial.
        J Arthroplasty. 2021;
        • Smith A.F.
        • Usmani R.H.
        • Wilson K.D.
        • Smith L.S.
        • Malkani A.L.
        Effect of Tourniquet Use on Patient Outcomes After Cementless Total Knee Arthroplasty: A Randomized Controlled Trial.
        J Arthroplasty. 2021;
        • McCarthy Deering E.
        • Hu S.Y.
        • Abdulkarim A.
        Does Tourniquet Use in TKA Increase Postoperative Pain? A Systematic Review and Meta-analysis.
        Clin Orthop Relat Res. 2019; 477: 547-558
        • Huang Z.
        • Xie X.
        • Li L.
        • Huang Q.
        • Ma J.
        • Shen B.
        • et al.
        Intravenous and Topical Tranexamic Acid Alone Are Superior to Tourniquet Use for Primary Total Knee Arthroplasty.
        J Bone Jt Surg. 2017; 99: 2053-2061
        • Rathod P.
        • Deshmukh A.
        • Robinson J.
        • Greiz M.
        • Ranawat A.
        • Rodriguez J.
        Does Tourniquet Time in Primary Total Knee Arthroplasty Influence Clinical Recovery?.
        J Knee Surg. 2014; 28: 335-342
        • Zhao H.Y.
        • Yeersheng R.
        • Kang X.W.
        • Xia Y.Y.
        • Kang P.D.
        • Wang W.J.
        The effect of tourniquet uses on total blood loss, early function, and pain after primary total knee arthroplasty a prospective, randomized controlled trial.
        Bone Jt Res. 2020; 9: 322-332
        • Ejaz A.
        • Laursen A.C.
        • Kappel A.
        • Laursen M.B.
        • Jakobsen T.
        • Rasmussen S.
        • et al.
        Faster recovery without the use of a tourniquet in total knee arthroplasty.
        Acta Orthop. 2014; 85: 422-426
        • Mutlu S.
        • Guler O.
        • Mutlu H.
        • Karaman O.
        • Duymus T.M.
        • Parmaksizoglu A.S.
        Tourniquet use during total knee arthroplasty does not offer significant benefit: A retrospective cohort study.
        Int J Surg. 2015; 18: 123-127