The use of tourniquet may influence the cement mantle thickness under the tibial implant during total knee arthroplasty.

Abstract

It is still unknown whether the creation of blood-free surfaces by the use of tourniquet during total knee arthroplasty (TKA) has an influence on cement penetration and on implant fixation. The aim of this study is to evaluate the cement mantle under tibial component and the occurrence of progressive radiolucent lines (RLLs) according to the use of tourniquet in primary TKA. Fifty patients undergone TKA without the use of tourniquet (group 1) were well matched regarding baseline characteristics with 50 TKAs with the use of tourniquet (group 2). Patients were followed up prospectively. Cement mantle thickness was measured using immediate postoperative X-rays, and the occurrence of progressive radiolucency was finally evaluated in 3-year follow-up. New Knee Society Score (KSS) was used to compare clinical outcome between groups. Mean cement mantle thickness was 9.27 ± 1.86 mm in group 1 versus 10.49 ± 2.31 mm in group 2 (p = 0.005). Mean cumulated width of RLLs in anterioposterior (AP) view was 7.74 ± 6.68 mm in group 1 versus 3.48 ± 4.69 mm in group 2 (p < 0.001). The percentage of RLLs in AP view was related to the cumulated cement mantle thickness in the same view (r = - 0.218, p < 0.05). There was no significant difference between groups at the final follow-up in terms of ROM and new KSS. Our results suggest that the use of tourniquet increased the cement mantle thickness under tibial implant and had an influence on the occurrence of RLLs in cement-bone interface, which is related to implant survivorship, with this implant design.