Journal article
Time to reconsider the routine use of tourniquets in total knee arthroplasty surgery: an abridged version of a Cochrane systematic review and meta-analysis
- Abstract:
-
Aims
Many surgeons choose to perform total knee arthroplasty (TKA) surgery with the aid of a tourniquet. A tourniquet is a device that fits around the leg and restricts blood flow to the limb. There is a need to understand whether tourniquets are safe, and if they benefit, or harm, patients. The aim of this study was to determine the benefits and harms of tourniquet use in TKA surgery.Methods
We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled trials, and trial registries up to 26 March 2020. We included randomized controlled trials (RCTs), comparing TKA with a tourniquet versus without a tourniquet. Outcomes included: pain, function, serious adverse events (SAEs), blood loss, implant stability, duration of surgery, and length of hospital stay.Results
We included 41 RCTs with 2,819 participants. SAEs were significantly more common in the tourniquet group (53/901 vs 26/898, tourniquet vs no tourniquet respectively) (risk ratio 1.73 (95% confidence interval (CI) 1.10 to 2.73). The mean pain score on the first postoperative day was 1.25 points higher (95% CI 0.32 to 2.19) in the tourniquet group. Overall blood loss did not differ between groups (mean difference 8.61 ml; 95% CI -83.76 to 100.97). The mean length of hospital stay was 0.34 days longer in the group that had surgery with a tourniquet (95% CI 0.03 to 0.64) and the mean duration of surgery was 3.7 minutes shorter (95% CI -5.53 to -1.87).Conclusion
TKA with a tourniquet is associated with an increased risk of SAEs, pain, and a marginally longer hospital stay. The only finding in favour of tourniquet use was a shorter time in theatre. The results make it difficult to justify the routine use of a tourniquet in TKA surgery.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
Actions
Access Document
- Files:
-
-
(Preview, Version of record, 638.2KB, Terms of use)
-
- Publisher copy:
- 10.1302/0301-620x.103b.bjj-2020-1926.r1
Authors
- Publisher:
- British Editorial Society of Bone and Joint Surgery
- Journal:
- Bone and Joint Journal More from this journal
- Volume:
- 103-B
- Issue:
- 5
- Pages:
- 830-839
- Publication date:
- 2021-03-08
- DOI:
- EISSN:
-
2049-4408
- ISSN:
-
2049-4394
- Pmid:
-
33683139
- Language:
-
English
- Keywords:
- Pubs id:
-
1166740
- Local pid:
-
pubs:1166740
- Deposit date:
-
2021-10-29
Terms of use
- Copyright holder:
- Ahmed et al.
- Copyright date:
- 2021
- Rights statement:
- © 2021 Author(s) et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited.
If you are the owner of this record, you can report an update to it here: Report update to this record