To Cement or Not to Cement a Total Knee

Hedge et al from University of Colorado and Colorado Joint Replacement (Doug Dennis’s group) has reported on their 5 year outcomes of tourniquet versus no tourniquet (0 minutes) in total knee arthroplasty. They reported significantly better cement penetration in tourniquet group and significantly less radiolucent lines. The no tourniquet group had two aseptic knee revisions for loosening versus none in the tourniquet group.

Like everything in life, there are risks and benefits with every decision we make. No tourniquet, has been a trend in orthopaedics, that results in less postoperative pain than using a tourniquet. The trade off is that interdigitation of cement may be affected which results in earlier and higher failure rates. This study highlights that concern. I think the one of the most important reasons to use a tourniquet is that this data is reported by a surgeon who has been a strong proponent of “no tourniquet”, which may be different now that this study is out.

I use a tourniquet and will continue to do so for this reason. There are contraindications for tourniquet use which I respect as well.