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Table 4 Prospective randomized controlled trials reported the effect of tourniquet pressure during total knee arthroplasty

From: Is lower tourniquet pressure during total knee arthroplasty effective? A prospective randomized controlled trial

Author (Year) Country Group [HTP] (N) vs. [LTP] (N) Actual tourniquet pressure (mmHg) Duration (min) Release timing* Anesthesia Tourniquet failure Effect of lower tourniquet pressure
Worland (1997) [14] USA [350 mmHg] (28) vs.
[SBP + 100 mmHg] (28)
350 vs. 230 23 vs. 22 Early Spinal NA Provide bloodless operative field,
Less thigh pain
Clarke (2001) [12] England [SBP + 250 mmHg] (10) vs. [SBP + 125 mmHg] (11) 352 vs. 223 52–94 vs. 45–91 NA General 0/10 (HTP) 1/11 (LTP) Less postoperative wound hypoxia
Manén Berga (2002) [16] Spain [400 mmHg] (41) vs.
[SBP + 100 mmHg] (45)
400 vs. 260 77.4 vs. 73.7 Late Spinal 2/45 (LTP) Less postoperative pain, Provide bloodless operative field,
Fast recovery of ROM
Ishii (2005) [15] Japan [350 mmHg] (30) vs.
[SBP + 100 mmHg] (30)
350 vs. 238 50 vs. 48 Early Spinal NA Provide bloodless operative field,
No difference in perioperative blood loss
Olivecrona (2012) [4] Sweden [SBP + adequate margin] (76) vs. [LOP + safety margin] (83) 252 vs. 246 87 vs. 87 NA Spinal or General 3/159 (Total) No postoperative infections and less wound complications in cuff pressure < 225 mmHg
Tuncali (2018) [27] Turkey [LOP + adequate margin] (46) vs. [estimated AOP + 20mHg] (47) 200 vs. 182 70 vs. 66 NA Combined spinal epidural 0 (Total) Excellent or good tourniquet performance in all patients,
No tourniquet related complications
The current study Korea HTP [SBP + 150 mmHg] (80) vs. LTP [SBP + 120 mmHg] (80) 255 vs. 234 83 vs. 82 Early (& reinflation) Spinal 1/80 (HTP) 2/80 (LTP) Provide bloodless operative field,
No difference in postoperative pain, thigh complication, VTE, and delayed rehabilitation
  1. *Timing of the tourniquet release was defined as one of two methods: late release (tourniquet was released after wound closure) or early release (tourniquet was released after implant fixation and before wound closure). In the current study, the tourniquet was released early after implant fixation for the arterial hemostasis and reinflated after hemostasis [20]
  2. HTP higher tourniquet pressure, LTP lower tourniquet pressure, RCT randomized controlled trial, SBP systolic blood pressure, LOP limb occlusion pressure, AOP arterial occlusion pressure, NA not applicable, ROM range of motion, HSS Hospital for Special Surgery, SLR straight leg raise, VTE venous thromboembolism