J Knee Surg 2019; 32(08): 719-729
DOI: 10.1055/s-0039-1681035
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Tourniquet Use in Total Knee Arthroplasty

Jaymeson R. Arthur
1   Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona
,
Mark J. Spangehl
1   Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona
› Author Affiliations
Further Information

Publication History

02 January 2019

10 January 2019

Publication Date:
01 March 2019 (online)

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Abstract

Tourniquet use in total knee arthroplasty has become a controversial topic. There are several benefits of its use including improved visualization, decreased blood loss, shorter operative times, and improved antibiotic delivery. Conversely, there are several significant downsides associated with tourniquet use including postoperative pain, neuromuscular injuries, wound complications, reperfusion injury, increased risk of thrombosis, patellar tracking issues, delayed rehabilitation including decreased postoperative range of motion, and its negative effect on patients with vascular disease. However, objectively, the literature does not definitively push us toward or away from the use of a tourniquet. Furthermore, several alternatives have been developed to help mitigate some of the adverse effects associated with its use. This article summarizes the evidence for and against tourniquet use and provides an evidence-based approach to help guide surgeons in their own practice.