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