2015 ISAKOS Biennial Congress ePoster #1413

How to Reduce Blistering After Total Knee Arthroplasty: Release the Tourniquet Before Dressing Application

Snir Heller, MD, Philadelphia, PA UNITED STATES
Antonia F. Chen, MD, MBA, Newton, MA UNITED STATES
Emily Albert, BS, Philadelphia, PA UNITED STATES
William J. Hozack, MD, Philadelphia, PA UNITED STATES

Rothman Institute, Philadelphia, PA, USA

FDA Status Not Applicable

Summary: Releasing the tourniquet prior to dressing application reduces the incidence of blistering after total knee arthroplasty.




Blisters occur in up to 20% of patients after total knee arthroplasty (TKA) and are associated with superficial and deep infections. Tourniquet release after TKA results in a limb volume increase of 10%. Application of a circumferential compression dressing prior to tourniquet release may cause shearing forces between the skin layers and the attached dressing and lead to blistering. The purpose of this study is to evaluate if releasing the tourniquet before the dressing application correlates with decreased blister formation following TKA.


A prospective study was conducted on 135 consecutive primary TKAs (111 patients) performed between December 2013 and June 2014. Patients with prior knee surgeries were excluded. The tourniquet was released immediately after wound closure to allow for complete reperfusion of the limb and a compression dressing was subsequently applied. These patients were compared to a historical cohort of 200 consecutive primary TKAs (187 patients) where the tourniquet was released after wound closure and application of a compressive dressing. Patients were followed for 30 days to determine the incidence of blistering. All TKAs were performed by the same surgeon using the same surgical technique. Dressings and perioperative care were also the same between the groups.


The incidence of blistering in patients where the tourniquet was released after dressing application was 7.5% (15/200), while the incidence of blistering in the group where the tourniquet was release prior to dressing application was 2.2% (3/135). This represents a statistically significant reduction in blistering (p=0.028). Patients’ age, gender, ethnicity, body mass index, tourniquet time and calculated blood loss were similar between groups.


Blisters form as a result of a mechanical separation between the dermis and the epidermis. A compression dressing applied prior to release of the tourniquet and prior to limb reperfusion may lead to blistering. Releasing the tourniquet prior to dressing application reduces the incidence of blistering after TKA.