Hemostasis of Suprapatellar Synovium and Arthrotomy Site Prior to Tourniquet Inflation Reduce Blood Loss After Total Knee Arthroplasty: A Randomized Controlled Trial

The knee and extensor mechanism receives a rich blood supply from the anastomosis of multiple genicular arteries. We hypothesized that meticulous hemostasis of the suprapatellar synovium and surrounding soft tissues of the arthrotomy site prior to tourniquet inflation might reduce blood loss and pain after total knee arthroplasty (TKA). This randomized controlled trial included 60 patients undergoing unilateral TKA. Patients were randomly allocated into 1) the hemostasis group, bleeding vessels after arthrotomy and suprapatellar synovectomy were identified and cauterized before tourniquet inflation, and 2) the control group, the tourniquet was inflated before incision without identifying bleeding vessels. For both groups, the tourniquet was released after wound closure. Outcomes included intraoperative estimated blood loss (EBL), drain output, total blood loss (TBL), blood transfusion rate, numerical rating scales (NRSs) for pain and morphine consumption during the first 48 h ( h ) after TKA, and length of hospital stay (LHS). The demographics of both groups were comparable. The hemostasis group had significantly shorter tourniquet time (84.5 vs. 99.5 min, p = 0.01), higher intraoperative EBL (55.3 vs. 32.7 mL, p < 0.01), lower drain output (279.3 vs. 384.7 mL, p < 0.01), and lower blood transfusion rates (13.3 vs. 43.3%, p = 0.02). Additionally, the hemostasis group had lower NRS pain scores at 24 h (4.1 vs. 5.8, p < 0.01) and 48 h (2.8 vs. 3.6, p < 0.01) and less morphine consumption in the first 24 h (4.0 vs. 5.5 mg, p < 0.01) and from 24 to 48 h (1.5 vs. 3.3 mg, p < 0.01), as well as shorter LHS. Hemostasis of the suprapatellar synovium and arthrotomy site prior to tourniquet inflation significantly reduced blood loss and transfusion requirements. Furthermore, this alternative approach leads to significantly lower VAS pain scores, reduced morphine consumption within the first 48 h post‐TKA, and shorter lengths of hospital stay.