The effect of tourniquet use on fixation quality in cemented total knee arthroplasty a prospective randomized clinical controlled RSA trial

Knee. 2014 Mar;21(2):396-401. doi: 10.1016/j.knee.2013.10.008. Epub 2013 Oct 24.


Background: A concern that arises with any change in technique is whether it affects the long-term implant stability. The objective of this study was to evaluate the early migration, measured by radiostereometric analysis (RSA), and the functional outcome of the Triathlon™ cemented knee prosthesis, operated on with or without a tourniquet. During the last decades RSA has emerged as a way to assess prosthetic fixation and long time prognosis. The method has been used extensively in both hip and knee arthroplasty.

Method: This was a single centre prospective study including 60 patients randomized into two groups operated on either with or without tourniquet. RSA investigation was done within 2-3 days postoperatively after full weight bearing, and then at 3 months, 1 year and 2 years postoperatively.

Results: There were no differences between the groups regarding the translation along or rotation around the three coordinal axes, or in maximum total point motion (MTPM). At 2 years the mean MTPM (SD) was 0.71 mm (0.64) for the tourniquet-group and 0.53 mm (0.21) for the non-tourniquet-group.

Conclusions: The tibial tray of the Triathlon™ cemented knee prosthesis showed similar early stability whether operated on with or without tourniquet.

Level of evidence: Level I.

Article summary: Article focus: A safety study for total knee replacement operated on with or without perioperative tourniquet regarding the prosthetic fixation. Strengths and limitations: Strength of this study is that it is a randomized prospective trial using an objective measuring tool. The sample size of 25-30 patients is reportedly sufficient for the screening of implants using RSA (1-3).

Trial registration: Clinical trials NCT01604382, Ethics Committee approval D-nr: 144/20085.

Keywords: Prospective; RSA; Randomized; Total knee arthroplasty; Tourniquet.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Knee / methods*
  • Bone Cements*
  • Female
  • Follow-Up Studies
  • Humans
  • Knee Joint / physiopathology
  • Knee Joint / surgery
  • Knee Prosthesis*
  • Male
  • Osteoarthritis, Knee / surgery
  • Prospective Studies
  • Radiostereometric Analysis
  • Range of Motion, Articular / physiology
  • Rotation
  • Tourniquets*


  • Bone Cements

Associated data