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Randomized Controlled Trial
, 20 (1), 35

Comparison of Lower Limb Lifting and Squeeze Exsanguination Before Tourniquet Inflation During Total Knee Arthroplasty

Randomized Controlled Trial

Comparison of Lower Limb Lifting and Squeeze Exsanguination Before Tourniquet Inflation During Total Knee Arthroplasty

Meng Zhang et al. BMC Musculoskelet Disord.


Background: During total knee arthroplasty(TKA), tourniquet is widely used by most surgeons whereas the optimal application is still controversial. With this prospective randomized controlled study, we intend to investigate the effect of lower limb lifting and squeeze exsanguination methods on clinical outcomes in a series of TKAs.

Methods: Prospectively enrolled a total of 236 TKA patients from March, 2012 to November, 2016. Of which 118 patients randomly constitute Group A with lower limb lifting exsanguination technique; and the other 118 patients comprise Group B with squeeze exsanguination method. A year's follow-up measurements were recorded in detail for analysis.

Results: The pre-tourniquet time of Group A was significantly shorter than that in Group B (P < 0.001). Significant difference was found on skin tension blister, 3 happened in Group A and 11 happened in Group B (P = 0.031), which resulted in a difference in total complications (P = 0.039). The VAS score was significantly lower in Group A at one and seven days postoperatively, P < 0.001 and P = 0.011, respectively. No significant differences were found regarding all other clinical outcome measurements.

Conclusion: The lower limb lifting exsanguination is a safe and effective technique. Compared with squeeze exsanguination method, it could decrease the incidence of skin tension blister and alleviate early postoperative pain reaction, no additional risks occurred regarding other clinical outcomes. Thus, it might have the potentiality to be commonly utilized in TKA procedure.

Trial registration: Identifier: ChiCTR1800020471. Registered on 31 December 2018 Retrospectively registered.

Keywords: Exsanguination; Skin tension blister; TKA; Tourniquet; VAS score.

Conflict of interest statement

Ethics approval and consent to participate

The Ethics Committee of the Affiliated HuaiAn No.1 people’s hospital of Nanjing Medical School approved the study protocol. Written informed consent was obtained from all patients enrolled in the investigation.

Consent for publication

Not applicable.

Competing interests

The authors declared that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.


Fig. 1
Fig. 1
a: The leg elevation exsanguination method; b: The hand-over-hand squeeze exsanguination method
Fig. 2
Fig. 2
Patients’ flowchart
Fig. 3
Fig. 3
Trends of VAS and ROM with the follow-up time. * indicates a significant difference
Fig. 4
Fig. 4
An example of the skin tension blister 1 day postoperatively (the circles)
Fig. 5
Fig. 5
The histogram shows the complications between the groups, * indicates a significant difference

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