Extended Tourniquet Use in Knee Replacement Leads to Necrotic Tissue

Can you describe your experience performing knee replacement surgery?

I bring thirty years of experience as a board-certified orthopedic surgeon specializing in joint replacements. I perform total knee replacement operations approximately 150 times annually.

What is the role of a tourniquet in this procedure, and what is the standard of care in its use to avoid adverse events?

In total knee replacement operations, a tourniquet’s role is crucial for maintaining a clean, dry field during component cementation, ensuring an optimal cement bond to bone. Recent studies have questioned the necessity of tourniquets for cementing knee replacements. These studies suggest that prepared bone surfaces can be satisfactorily cleaned and dried without halting circulation to the leg. Under these circumstances, the cement bond to the bone remains satisfactory.

However, these studies lack long-term results; hence, the current standard of care advocates limited use of a tourniquet for cementation, rather than performing all knee replacement operations without one. Given the reported adverse events associated with tourniquet use, orthopedic researchers are studying these issues to continue serving patients effectively while ensuring their safety and avoiding complications.