Release of ischaemia prior to wound closure in total knee arthroplasty: a better method?

We included 46 total knee arthroplasties (43 patients) in a prospective, randomised study, dividing them into two groups: group A (23 knees, 21 patients) in which the ischaemia was released prior to wound closure allowing control of bleeding and group B (23 knees, 22 patients) releasing the tourniquet after suturing and bandaging. We compared the haemoglobin before surgery and at 24 and 48 h postoperatively, the total blood loss and the transfusions that were needed. Student's t-test was used to analyse the data. The results we obtained were as follows: preoperative haemoglobin in group A was 14.21 g/dl and group B 14.28 g/dl; haemoglobin at 24/48 h for group A was 10.04/10.1 g/dl and group B 10.28/10.3 g/dl; total blood loss was 743.2 cc for group A and 692.5 cc for group B; the mean number of blood units transfused were 2 in group A and 1.8 in group B. No statistical differences were found in the data analysed, but one of the complications in group B was major blood loss right after surgery that needed reintervention. We assume that this could have been avoided if the tourniquet had been released beforehand. We conclude that releasing ischaemia prior to wound closure does not demonstrate a statistical difference, but like other authors, we found clinical advantages suggesting the need of further study of this situation.