Surgical tourniquet use in total knee replacement surgery : a survey of BASK members

Traditionally, a surgical tourniquet is used during total knee replacement (TKR) surgery to help provide a bloodless field, and some surgeons believe this improves the quality of component cementation.[1] In 2003 over 93% of TKRs reported in the National Joint Registry were performed with a tourniquet.[2] However, now, evidence is emerging that using a tourniquet increases the risk of post-operative venous thromboembolism and is associated with higher levels of post-operative pain.[3] In addition, echogenic material, suggestive of emboli has been observed in the brain following surgical tourniquet deflation in total knee replacement surgery. It is thought that this may occur despite the absence of a patent foramen ovale, likely through pulmonary shunts.[4] The aim of this study was to capture contemporary surgical practice and establish the extent to which BASK members undertake total knee replacement surgery with the aid of a tourniquet. We also aimed to establish those members who would consider changing their practice as part of a research study to evaluate the benefits and risks of tourniquets