Tourniquet-less total knee arthroplasty does not negatively affect cement penetration: a double-blinded randomized controlled trial.

backgroundThe use of tourniquets in total knee arthroplasty (TKA) remains controversial, with growing interest in tourniquet-less techniques to improve patient outcomes. However, concerns persist regarding the adequacy of cement penetration and long-term implant stability. This study evaluated whether tourniquet-less TKA compromises cement penetration compared to conventional tourniquet-assisted procedures.

methodsA double-blind randomized controlled trial included 120 patients with end-stage osteoarthritis undergoing cemented TKA. Patients were randomized into two groups: tourniquet (n = 60) and tourniquet-less (n = 60). All patients received standardized protocols including tranexamic acid, spinal anaesthesia with controlled hypotension, and identical cementing techniques. The primary outcome was cement penetration depth measured on standardized radiographs at 60 days. Secondary analysis assessed the impact of bone mineral density on cement penetration.

resultsBoth groups achieved optimal cement penetration (2–3 mm) across the measured zones, with no clinically significant differences in average penetration depth. Bone mineral density did not affect penetration in either group, with 28.9% of patients having osteoporosis. Statistically significant differences in select zones (0.06–0.5 mm) were not clinically meaningful.

conclusionsTourniquet-less TKA achieves equivalent cement penetration to tourniquet-assisted procedures when performed with modern standardized techniques. These findings support surgical decision-making for tourniquet-less approaches without compromising implant fixation quality, potentially enabling improved patient-centered outcomes.