EDUCATIONAL OBJECTIVES As a result of reading this article, physicians should be able to: 1. Describe the available tourniquet application strategies for patients treated with total knee arthroplasty (TKA). 2. Differentiate the potential strengths and limitations of tourniquet release before and after wound closure in TKA. 3. Cite the available evidence regarding tourniquet release before and after wound closure in TKA. 4. Recognize the optimal tourniquet application strategy in TKA based on the available evidence. The authors conducted a meta-analysis to determine the optimal tourniquet application strategy in total knee arthroplasty (TKA). Fourteen high-quality randomized, controlled trials were retrieved. The results showed tourniquet release before wound closure for hemostasis could significantly increase not only the total measured blood loss but also the calculated blood loss in patients treated with TKA, regardless of fixation type. With proper control of the amount of pressure (less than 293 mm Hg) and the duration of application (less than 150 minutes), tourniquet release after wound closure can reduce blood loss in patients treated with primary TKA without increasing the risk of complications. [Orthopedics. 2015; 38(7):445-451.].
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