Orthopedic Surgery

Tourniquet Use During Total Knee Arthroplasty Reduces Blood Loss

During total knee arthroplasty (TKA), using a tourniquet is the key to reducing blood loss compared with the application of tranexamic acid (TXA), according to the results of a retrospective cohort study.

To compare the efficacy of these 2 methods when used either alone or together in reducing blood loss during TKA, the researchers studied a cohort of patients who had this procedure in the orthopedic surgery department of a tertiary care center between January 2019 and October 2020.

The study’s primary outcomes were procedure length in minutes, estimated blood loss in milliliters, and total milligrams of phenylephrine pressor given by infusion during surgery. The researchers then used means and standard errors to summarize their findings and one-way ANOVA, probability plots, the Shapiro-Wilk test for normality, the Kruskal-Wallis test, and Tukey’s test to analyze the data.

The researchers reviewed the charts of the study’s 526 participants to determine which methods, if any, had been used to reduce blood loss during TKA and found that TXA alone was used in 104 participants, tourniquet alone was used in 122, both methods were used in 264, and neither method was used in 36.

No significant difference was found between groups in procedure length or total amount of pressor received via infusion. However, they did differ in total amount of blood loss (P < .001). More specifically, participants who did not receive TXA or a tourniquet lost significantly more blood than those who received TXA plus a tourniquet or a tourniquet alone. Similarly, those who received TXA alone lost significantly more blood than those who received TXA plus a tourniquet or a tourniquet alone.

“This study supports the conclusion that the use of a tourniquet is superior to the use of TXA in reducing intraoperative blood loss during TKA,” the researchers wrote.

—Ellen Kurek


Kukreja P, Johnson BM, Traylor C, et al. Comparison of the utilization of tranexamic acid and tourniquet use in total knee arthroplasty: a retrospective case series. Cureus. 2022;14(5):e24842. doi:10.7759/cureus.24842