TKR without tourniquet: A laboratory study investigating the quality of the tibial cement mantle when using metaphyseal suction and cement gun

Purpose The majority of cemented knee replacements worldwide are performed with a tourniquet. The benefits of surgery in TKR without a tourniquet have been well described but questions have been raised about the ability to prepare the bone for cementation, and take up of a tourniquet-less technique has been slow. A laboratory based model was constructed to directly compare the quality of cementing between tourniquet and tourniquet-less knee replacement supplemented by metaphyseal suction and a cement gun. Methods A Sawbone model to represent the metaphyseal proximal tibia was constructed. The model allowed the inflow of simulated blood and the use of metaphyseal suction. The study compared four different techniques; the use of a tourniquet, no tourniquet, no tourniquet with cancellous suction and no tourniquet with cancellous suction and a cement gun. Each subtype of experiment was repeated 5 times. Quality of cementation was assessed using a calibrated engineering planimeter. Results This model has shown that combining the use of metaphyseal suction and a cement gun but without the use of a tourniquet offers significantly better cement penetration (p Conclusions This study offers further in vitro evidence to the argument that tourniquet-less surgery when supplemented by appropriate techniques can achieve a good cement–bone interface, whilst avoiding the additional risk of using a tourniquet to perform the procedure.