Tourniquet Application During Total Knee Arthroplasty Does Not Benefit Perioperative Blood Loss or Transfusion Requirement with the Routine Use of Tranexamic Acid

Abstract Background : The use of a tourniquet during total knee arthroplasty (TKA) continues to be a matter of debate. Advantages of tourniquet use include improved visualization, decreased intraoperative and total blood loss, and possibly decreased transfusion requirement. However, the recent widespread adoption of antifibrinolytic therapy with tranexamic acid (TXA), may negate these benefits. The purpose of this study was to evaluate perioperative blood loss and transfusion requirement with two different tourniquet application strategies, and surgery without the use of a tourniquet during routine, primary cemented TKA. Methods : A retrospective cohort study was performed of 300 patients undergoing TKA at a single institution after the implementation of a routine intravenous TXA administration protocol and consisted of three groups based on tourniquet usage: tourniquet inflation before incision and deflation following cement hardening (TQ), tourniquet inflation prior to cement application and deflation following hardening (Partial TQ), and no tourniquet usage (No TQ). Each group consisted of 100 consecutive patients. Perioperative blood loss, change in hematocrit and transfusion requirement were compared between groups.  Results : Total blood loss (estimated blood loss and drain output) was lowest in the TQ group, however this was only due a slight decrease in intraoperative estimated blood loss. There was no difference in post-operative drain output, or change in hematocrit levels from preoperative values. There were no transfusions in the Partial TQ and No TQ groups, whereas there were 5 transfusions in the TQ group. Conclusions : In the era of routine TXA administration during TKA, tourniquet usage does not appear to have a benefit in regards to perioperative blood loss or transfusion requirement.