**3.2. Operation time**

palsy, ischemia [9], soft tissue damage, thromboembolic complications [10], decrease muscle strength [11], and knee range of motion (ROM) [3]. In spite of the common use of tourniquet in orthopedic surgeries, the role of tourniquet in TKA remains controversial, and some sur-

To reduce the aforementioned drawbacks, adjunctive measures such as skin protection [14], elastic cuff [15], and reducing cuff pressure [16, 17] are frequently taken while applying the tourniquet during TKAs. Recently, early deflation of tourniquet has drawn increasing attention. Since most surgeons use tourniquet to facilitate the procedure mainly, there are no need for prolonged use of tourniquet. Various timings of deflation have been proposed in the literature, such as deflating tourniquet after cementing the implants [18–20], after closure of arthrotomy [21], or immediately after wound closure [22]. However, no consensus has been achieved to date.

To clarify the role of tourniquet in TKA, a comprehensive review was therefore conducted. An extensive search as well as review of the related literature regarding the tourniquet use was

Our review team completed the search of electronic databases, including the Cochrane Central Register of Controlled Trials (2010), PubMed Medline (1966 to May 2011), and Embase (1980 to May 2011). We used the following search terms and Boolean operators: (tourniquet) AND (knee OR arthroplasty OR joint replacement). We also searched the reference lists of the relevant articles for any further associated studies. The criteria for inclusion were (1) reports dealing with patients undergoing primary TKA and (2) studies about tourniquet use. After reviewing the titles and abstracts of the studies, we determined if the study was appropriate for retrieval. The retrieved literature was completely reviewed. A consensus about the content

Whether or not a tourniquet can reduce blood loss in total knee arthroplasty is still being debated in the literature. Although intraoperative blood loss was significantly less in the tourniquet group in the present study, there is often a substantial hidden or unmeasured blood loss in TKA. Some authors claimed that a tourniquet is effective for reducing blood loss [1, 2, 23],

geons suggested that tourniquet is not necessary [12, 13].

performed. This review focused on:

82 Primary Total Knee Arthroplasty

**1.** Effectiveness of tourniquet use in TKA.

**3.** Effect of early deflation of tourniquet.

**3. Intraoperative tourniquet use**

**3.1. Blood loss**

**2. Search of literature**

**2.** Safety and complications of tourniquet use in TKA.

of this review article was reached throughout series of discussion.

The application of a tourniquet in TKA was believed to afford a relative bloodless surgical field, facilitating time saving. However, the critical timing of deflation should be mentioned regarding the operation time. The pooling data showed significantly shortened surgical duration in the tourniquet group once the tourniquet was released after wound closure and compressive dressing [2, 27, 30]. In comparison, early release of the tourniquet right after cementing the prosthesis for hemostasis would prolong the operation time for troublesome oozing [5, 20, 31–34]. Thus, the studies with early release of tourniquet did not correlate with significant shortened operation time [23, 24, 26].
