Extended Tourniquet Use in Knee Replacement Leads to Necrotic Tissue

Case Overview

This case study revolves around a 53-year-old patient who underwent a knee replacement procedure in 2020. A tourniquet was applied above the knee during the operation to maintain a sterile and dry surgical field. However, allegations arose that the surgeon left the tourniquet in place for an excessive duration, leading to necrotic tissue development within the surgical area.

As a result, a plastic surgeon performed a subsequent lateral gastrocnemius muscle flap procedure to correct the damage. An expert opinion from an orthopedic surgeon was sought to provide insight into the standard use of a tourniquet during such procedures.

Questions to the expert and their responses

Can you describe your experience performing knee replacement surgery?

I bring thirty years of experience as a board-certified orthopedic surgeon specializing in joint replacements. I perform total knee replacement operations approximately 150 times annually.

What is the role of a tourniquet in this procedure, and what is the standard of care in its use to avoid adverse events?

In total knee replacement operations, a tourniquet’s role is crucial for maintaining a clean, dry field during component cementation, ensuring an optimal cement bond to bone. Recent studies have questioned the necessity of tourniquets for cementing knee replacements. These studies suggest that prepared bone surfaces can be satisfactorily cleaned and dried without halting circulation to the leg. Under these circumstances, the cement bond to the bone remains satisfactory.

However, these studies lack long-term results; hence, the current standard of care advocates limited use of a tourniquet for cementation, rather than performing all knee replacement operations without one. Given the reported adverse events associated with tourniquet use, orthopedic researchers are studying these issues to continue serving patients effectively while ensuring their safety and avoiding complications.

About the expert

This expert is a seasoned orthopedic surgeon with over 30 years of experience, specializing in adult reconstructive surgery. They have an extensive educational background, including an MD and MBA in health care management, and have completed a fellowship in adult total joint reconstruction. Currently serving as an orthopedic surgeon at a prominent health system and the chief of orthopedic surgery at a local hospital, they also contribute to academia as a clinical assistant professor and residency program advisor. Their expertise lies in adult reconstruction, arthroscopic reconstruction, general orthopedics, and anterior hip replacements, making them highly relevant for this case study involving knee replacement surgery.