TIMING OF TOURNIQUET RELEASE IN TOTAL KNEE ARTHROPLASTY AND ITS EFFECT ON POST OPERATIVE COMPLICATIONS

ABSTRACT
Objective: To evaluate whether early tourniquet release in total knee arthroplasty in better than late tourniquet release
in decreasing total blood loss, transfusion requirements, duration of tourniquet, duration of surgery, total hospital stay,
post operative pain and early post operative complications.
Material and Method: This study was conducted at department of orthopeadic and spine surgery hayatabad medical
complex Peshawar and a private clinic from January 2013 to July 2016. A total of 38 knees (36 patients) were included in
the study and were divided into two groups containing 19 knees (18 patients) each. Group A included patients in whom
tourniquet was released after components fixation and group B included patients in whom tourniquet was released
after complete wound closure. Inclusion criteria were, patients suffering from osteoarthritis, rheumatoid arthritis or any
other type of knee arthritis. Exclusion criteria was patients suffering from thromboembolic disease or previous history
of DVT, anticoagulant treatment, ischemic heart disease or cardiovascular surgery, bleeding or coagulation disorder,
previous surgery of knee and age more than 80 years were excluded from the study. Blood loss and other variables
were noted in each group.
Results: Mean age of the patient in both groups was 58.6+/-8.2 years (42-80 years) 28 TKA patients were female(74%)
and 10 (26%) were male patients. 04 knees (11%) were operated as simultaneous bilateral procedures while 34 knees
(89%) as a single TKA at a time. Right knee was operated in 20 patients (53%) and left knee in 18 patients (47%).mean
pre operative hemoglobin (HB%) was 12.4g/dl in both the groups while post operative HB was 9.6 g/dl in group A
and 9.9 g/dl in group B. average blood loss in group A was 756 ml and in group B it was 734 ml which in statistically
insignificant. Transfusion requirements were comparable in both the groups. Two wound complications were noted in
group B, one patient was conservatively treated with antibiotics and second patient required exploration of the wound
which revealed a bleeder in posterior capsule, which was treated accordingly.
Conclusion: Early tourniquet release does not decre