Introduction Totalkneearthroplasty(TKA)isassociatedwithsignificant blood loss. Reported blood loss for single TKA varies between 600 ml to 2 liters. 1,2 In elderly patients undergoing simultaneous bilateral knee replacements, thelosssometimesleadstocatastrophicresults. Allogenic blood transfusions are required in 50-60% of such cases to treat acute blood loss and to prevent potentialcardiovascularrisks. 3 Allogenicbloodtransfusion itself has its complications, like immunologic reactions, infectiontransmissionandimmunosuppression. 3,4 A variety of blood-conserving techniques have been developedtoreducebloodlossandavoidallogenicblood transfusions, such as preoperative blood donation, perioperative red cell salvage, hypotensive anaesthesia, use of tourniquet and antifibrinolytic agents like tranexamicacid (TXA), Aproptin, E-Aminocaproic acid (EACA)etc. Use of tourniquet in TKA is a universally accepted phenomenon. It offers many advantages like minimal intraoperative blood loss, clear visualisation of operative field, shorter surgical time, improving the quality of cementation and ensuring long-term implant fixation. 5 There are, however, disadvantages associated with tourniquet use reportedly including thigh pain, muscle damage, nerve palsy, thromboembolic complications, poor wound healing and patellar maltracking. 6 Although theadvantagesoftourniquetuseduringTKAoutweighits disadvantages, but the most appropriate timing of the tourniquet release and its impact on total blood loss and functionaloutcomeisstillcontroversial. The current study was planned to compare the amount of blood loss, transfusion requirement, duration of surgery, duration of tourniquet and early complications between earlytourniquetreleasebeforeclosureandlatereleaseafter closure,withandwithouttheuseofanti-fibrinolyticagent. Patients and Methods The quasi-experimental study was conducted in Orthopaedic Department of the Combined Military Hospital (CMH), Rawalpindi, between March and August 2014. All consecutive patients undergoing primary unilateralorbilateralTKAwereconsideredforthestudy.In order to control for potential bias, patients with history of Vol. 65, No.11 (Suppl. 3), November 2015 29th Pak Orthocon 2015 S-77 1-3 Combined Military Hospital (CMH), Rawalpindi, 4,5 Department of Orthopaedics, Benazir Bhutto Hospital, Rawalpindi. Correspondence: Obaidur Rahman. Email: drobaid@hotmail.com ORIGINAL ARTICLE Early release of tourniquet in total knee arthroplasty: Is it worthwhile? ObaidurRahman, 1 SohailHafeez, 2 M.SohailAmin, 3 JahanzebAmeen, 4 RanaAdnan 5 Abstract Objective: To compare the effects of duration and timing of tourniquet release on perioperative blood loss, transfusion requirement, duration of surgery, length of hospital stay and early complications in total knee arthroplastywithandwithoutadditionalanti-fibrinolytictherapy. Methods: Theprospectivequasi-experimentalstudywasconductedattheCombinedMilitaryHospital,Rawalpindi, fromMarchtoAugust2014.Thepatientsundergoingtotalkneearthroplastyweredividedintotwogroups:inGroup A tourniquet was released after closure of surgical wound and applying compressive dressing; and in Group-B tourniquet was deflated after cementation of implants following which closure was done. Each group was further divided into those who received tranexamic acid (A-T, B-T) and those who did not (A-C, B-C). Study variables were notedonaproformaandanalysed. Results: Of the 75 patients in the study, 27(36%) were male and 48(64%) were females. Calculated blood loss was 408mL and 422mL in group A-T and B-T respectively (p=0.73), and 615mL and 610mL in group A-C and B-C respectively (p=0.95).Tourniquet time was significantly shorter (p<0.0005) in group B whereas duration of surgery wassignificantlyshorter(p<0.0001)ingroupA(68±9minvs77±11min).Transfusionfrequencywashigheringroup B. Complication rate in the two main groups was not significantly different (p=0.314). Mean length of hospital stay wasnotsignificantlydifferent(p>0.05). Conclusion: Earlier intra-operative release of tourniquet in patients undergoing total knee arthroplasty was associatedwithincreasedsurgerytimeandhigherfrequencyofbloodtransfusionwithoutconferringanysignificant benefit. Keywords: Totalkneearthroplasty,Tourniquettime,Bloodloss,Complications.(JPMA65:S-77(Suppl.3);2015)