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Lower Tourniquet Cuff Pressure Reduces Postoperative Wound Complications After Total Knee ArthroplastyA Randomized Controlled Study of 164 Patients
Charlotta Olivecrona, RN1; Sari Ponzer, MD, PhD1; Per Hamberg, MD, PhD1; Richard Blomfeldt, MD, PhD1
1 Section of Orthopaedics, Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet, SE-118 83 Stockholm, Sweden. E-mail address for C. Olivecrona: charlotta.olivecrona@sodersjukhuset.se. E-mail address for S. Ponzer: sari.ponzer@ki.se. E-mail address for P. Hamberg: per.hamberg@sodersjukhuset.se. E-mail address for R. Blomfeldt: richard.blomfeldt@sodersjukhuset.se
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Investigation performed at the Department of Orthopaedics, Södersjukhuset Karolinska Institutet, Stockholm, Sweden

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Dec 19;94(24):2216-2221. doi: 10.2106/JBJS.K.01492
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Measurement of limb occlusion pressure before surgery might lead to the use of a lower tourniquet cuff pressure during surgery and thereby reduce the risk of postoperative pain and complications. The primary aim of this study was to investigate whether the limb-occlusion-pressure method reduces the tourniquet cuff pressure used during total knee arthroplasty and if this leads to less postoperative pain compared with that experienced by patients on whom this method is not used. The secondary aim was to investigate whether there were any differences regarding the quality of the bloodless field, range of motion, and postoperative wound complications.


One hundred and sixty-four patients scheduled to be treated with a total knee arthroplasty were randomized to a control group or to undergo the intervention under study (the limb-occlusion-pressure [LOP] group). In the control group, the tourniquet cuff pressure was based on the patient’s systolic blood pressure and a margin decided by the surgeon (the routine method). In the LOP group, the tourniquet cuff pressure was based on the measurement of the limb occlusion pressure. The primary outcome measure was postoperative pain, and the secondary outcome measures were the quality of the bloodless field, knee motion, and wound-related complications at discharge and two months after surgery.


The tourniquet cuff pressure was significantly lower in the LOP group than in the control group (p < 0.001). We could not demonstrate any differences between the groups regarding postoperative pain or complications, although the number of postoperative complications was relatively high in both groups. However, at discharge forty of the forty-seven patients with a wound complication had had a cuff pressure above 225 mm Hg and at the two-month follow-up evaluation fourteen of the sixteen patients with a wound complication had had a cuff pressure above 225 mm Hg.


The limb-occlusion-pressure method reduces the cuff pressure without reducing the quality of the bloodless field, but there were no differences in outcomes between the groups. An important secondary finding was that patients with a cuff pressure of ≤225 mm Hg had no postoperative infections and a lower rate of wound complications.

Level of Evidence: 

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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