In another randomized controlled trial of 81 patients, results were improved visual analog scores [VAS] for pain at 24 hours. And a persistent timed up-and-go improvement in the tourniquetless group at 3 months (Alexandersson, et al., Knee Surgery, Sports Traumatology, Arthroscopy, 2019).
What about cement penetration, you might ask? A study looked at 3 different cohorts. Tourniquet on for the entire time, or tourniquet on just for cementing, or no tourniquet at all. And they demonstrated in a randomized trial of 69 knees in each cohort, no difference in cement penetration, but a difference in terms of improved pain and knee society scores in the no-tourniquet and in the short tourniquet groups compared to the long tourniquet (Ozkunt, et al., Medicine).
Another study, randomized trial, 20 patients in each group, similarly demonstrated no difference in cement penetration in any of the planes in which it was assessed. But more importantly there was less pain in the first 4 days, and there was increased quadriceps function at 6 weeks as measured by surface EMG assessment in the no tourniquet group (Liu, et al., KSRR). This is when I said, “Okay, this is it. I’m switching.”
You can’t do this alone. In order to do this, you need your anesthesiologist and you have to take your time and get all the bleeders so that you have a nice surgical field and you don’t have to worry about them later.
Cementing does require 2 irrigations. You irrigate first and then as cement is mixed you irrigate again. We use the suction at 90 degrees and it really takes out a lot of the blood and fatty contents quite effectively, allowing an appropriate and reproducible cement interdigitation to be achieved.
I would suggest to you that using this technique, you can get reproducible cement mantles just about every single time. In my view tranexamic acid yes; tourniquet no. Because tourniquet might be good for me, but tourniquetless is better for the patient.
Dr. Booth: So first let me thank Seth for inviting a prodigal son back to the Mecca of learning here at CCJR.
I heard this story about Jose’s transformation. A miracle is an extraordinary event manifesting divine intervention in human affairs. The miracle maker, of course, is St. Michael, who is now a great friend of Jose’s.
There are other saints who have espoused this from the same podium. However, like many of our religious figures, they’re not pure. Dr. Barrack, for instance, uses a tourniquet, but only for cementing. This is a very confused issue.
