• Visit Wangwittayakul Veterans General Hospital
  • Thanainit Chotanaphuti Phramongkutklao Hospital and College of Medicine
  • Saradej Khuangsirikul Phramongkutklao Hospital and College of Medicine
  • Songpol Trakulngernthai Phramongkutklao Hospital and College of Medicine



Toruniquet, Intraoperative soft tissue balance, Computer-assisted surgery, Total knee arthroplasty


Background: The acquirement of appropriate soft tissue balancing and accurate alignment is an essential procedure in total knee arthroplasty (TKA). Gap balancing affects the final knee kinematics , and inadequate correction of soft tissue imbalances is considered an important factor for early TKA failure. During total knee arthroplasty (TKA), tourniquets are widely used to provide clear visualization of the tissue. The aim of the present study was to evaluate the effect of a tourniquet on intraoperative soft tissue balance in CAS total knee arthroplasty. Method: In this prospective cohort study , patients were eligible for inclusion when they were scheduled for primary CAS TKA due to osteoarthritis , age between 50 and 75 years. Exclusion criteria were severe cardiac complaints , severe pulmonary disorders, Body Mass Index(BMD) > 35,severe coagulation disorder. Thirty knees operated by TKA using a navigation-assisted system (KICK system, DuPuy) were evaluated the soft tissue tension and compared between the tourniquet released and the tourniquet inflated in full extension (0°) and at 90° knee flexion. Result: In total, 30 consecutive patients undergoing CAS TKA met the inclusion criteria. There were differences but not statistically significant in terms of soft tissue tension in knee full extension medial side (p=0.616) , knee, full extension lateral side(p=0.780) , 90° knee flexion medial side (p=0.573) and 90° knee flexion lateral side (p=0.163) Conclusion: Our preliminary results showed that tourniquet application during CAS TKA did not significantly affect the soft tissue balance.


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Door LD, Boiardo RA. Technical considerations in total knee arthroplasty. Cali Orthoplant Relat Res 1986 (205) :5 DOI:

Insall J , Tria AJ , Scott WN. The total condylar knee prosthesis : the first 5 years. Clip Orthoplant Relat Res 1979 (145) : 68. DOI:

Insall JN , Binazzi R , Soudry M, et al. Total knee arthroplasty. Clin Orthop Relat Res 1985 (192) : 13. DOI:

Clemens U, Miehlke RK. Advanced navigation planning including soft tissue management. Orthopedics 2005;28(10 Suppl):s1259. DOI:

Matsumoto T, Muratsu H, Tsumura N, et al. Soft tissue balance measurement in posterior-stabilized total knee arthroplasty with a navigation system. J Arthro-?plasty 2009;24(3):358.? DOI:

Fukuda A, Hasegawa M, Kato K, Shi D, Sudo A, et al. (2007) Effect of tourniquet?application on deep vein thrombosis after total knee arthroplasty. Arch Orthop Trauma Surg 127: 671-675. DOI:

Vandenbussche E, Duranthon LD, Couturier M, Pidhorz L, Augereau B (2002)?The effect of tourniquet use in total knee arthroplasty. Int Orthop 26: 306-309. DOI:

Insall JN. Presidential address to The Knee Society. choices and compromises in total knee arthroplasty. Clin Orthop Relat Res. 1988;226:43–8. DOI:

Berger RA, Rubash HE, Seel MJ, et al. Determining the rotational alignment of the?femoral component in total knee arthroplasty using the epicondylar axis. Clin?Orthop Relat Res 1993(286):40. DOI:

Fehring TK, Odum S, Griffin WL, et al. Early failures in total knee arthroplasty. Clin?Orthop Relat Res 2001(392):315. DOI:

Sharkey PF, Hozack WJ, Rothman RH, et al. Insall Award paper. Why are total knee arthroplasties failing today Clin Orthop Relat Res 2002(404):7. DOI:

Insall JN : Surgery of the knee , ed 2. Churchill Living stone, Newyork, 1993.

Insall JN : Technique of total knee replacement. Instr Course Lect 30:324, 1981.

Insall JN, Easley ME. Surgical techniques and instrumentation in total knee arthroplasty. In: Insall JN, Scott WN, editors. Surgery of the knee. 3rd ed. NewYork: Churchill Livingstone; 2001. p. 1553.

Winemaker MJ. Perfect balance in total knee arthroplasty. J Arthroplasty 2002;17:2.? DOI:

Laskin RS, Rieger MA. The surgical technique for performing a total knee replacement arthroplasty. Orthop Clin North Am 1989;20:31.

Sambatakakis A, Attfield SF, Newton G. Quantification of soft-tissue imbalance in condylar knee arthroplasty. J Biomed Eng 1993;15:339. DOI:

Attfield SF, Warren-Forward M, Wilton T, et al. Measurement of soft tissue imbalance in total knee arthroplasty using electronic instrumentation. Med Eng Phys 1994;16:501. DOI:

Morris BA, D'Lima DD, Slamin J, et al. e-Knee: Evolution of the electronic knee prosthesis. J Bone Joint Surg [Am] 2001;83-A(Suppl 2):62. DOI:

Kaufman KR, Kovacevic N, Irby SE, et al. Instrumented implant for measuring tibiofemoral forces.?J Biomech 1996;29:667. DOI:

Wallace AL, Harris ML, Walsh WR, et al. Intraoperative assessment of tibiofemoral contact stresses in totalknee arthroplasty. J Arthroplasty 1998;13:923. DOI:




How to Cite

Wangwittayakul V, Chotanaphuti T, Khuangsirikul S, Trakulngernthai S. THE EFFECT OF A TOURNIQUET ON INTRAOPERATIVE SOFT TISSUE BALANCE IN CAS TOTAL KNEE ARTHROPLASTY. J Southeast Asian Med Res [Internet]. 2018 Dec. 26 [cited 2024 Apr. 17];2(2):92-7. Available from:



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