Research Summary

Total Knee Arthroplasty Without Tourniquet Does Not Increase Risks

Tourniquet-less total knee arthroplasty (TKA) does not increase the risk of perioperative transfusion rates when compared with tourniquet use, despite higher rates of intraoperative and total perioperative blood loss, according to a matched cohort analysis.

The researchers aimed to evaluate the postoperative clinical outcomes and complications that may occur in revision TKA with and without tourniquet use.

To gain a better understanding of the outcomes, the researchers conducted a retrospective review of 1904 patients who underwent revision TKA. After propensity score matching, a cohort of 548 patients was divided evenly into 2 groups, patients who had a tourniquet during surgery (n = 274), and patients who were tourniquet-less (n = 274).

After analysis, the researchers found that when compared to the tourniquet-less cohort, the tourniquet cohort had significantly less intraoperative blood loss (413.7 vs 353.2 mL, P < 0.01). Additionally, the tourniquet cohort had less perioperative blood loss (1548.7 vs 1417.8 mL, P < 0.01) when compared to the tourniquet-less cohort.

Although the researchers observed a difference in intraoperative and perioperative blood loss between the 2 cohorts, there was no significant differences in total perioperative transfusion rates (8.4% vs 6.6%, P = 0.43). The researchers noted that the tourniquet cohort had an increased length of hospital stay of 3.2 to 3.7 days (P < 0.001) and 30-day readmissions (P = 0.04)

“This study demonstrated that although omitting the tourniquet in revision TKA leads to markedly increased perioperative blood loss, notable differences in perioperative transfusion rates were not observed,” the researchers concluded.  “Furthermore, revision TKA without tourniquet use was associated with reduced postoperative length of stay, 30-day readmissions, and increased rage of flexion.”


—Jessica Ganga


Tirumala V, Klemt C, Oganseyan R, Walker P, Padmanabha A, Kwon YM. Outcomes of tourniquet-less revision total knee arthroplasty: a matched cohort analysis. J Am Acad Orthop Surg. 2021;29(24):1343-1352. doi:10.5435/JAAOS-D-20-00796