The mid-term and long-term effects of tourniquet use in total knee arthroplasty: systematic review

Wardah Rafaqat, Sudhesh Kumar, Tashfeen Ahmad, Zul Qarnain, Khalid Saeed Khan, Riaz Hussain Lakdawala

Research output: Contribution to journalReview articlepeer-review

1 Citation (Scopus)

Abstract

Purpose: A tourniquet is routinely used during total knee arthroplasty (TKA) to reduce intra-operative hemorrhage, though surgery without a tourniquet is becoming popular. To address concerns about the effect of blood at cement interfaces on long-term implant stability, we conducted a systematic review among patients undergoing total knee arthroplasty to determine if TKA with a tourniquet, compared to TKA without a tourniquet or with reduced tourniquet duration, is associated with better mid-term and long-term implant stability. Methods: A literature search was conducted without language restriction in PubMed, Cochrane database and Web of Science from conception to 17th March, 2021. Prospective cohorts, randomized and observational, that compared tourniquet use with a control group, followed patients for 3 months or more and reported outcomes concerning implant stability, limb function, pain and inflammation. Article selection, quality assessment according to the Revised Cochrane risk assessment scale and Newcastle Ottawa Scale, and data extraction were conducted in duplicate. PROSPERO: CRD42020179020. Results: The search yielded 4868 articles, from which 16 randomized controlled trials (RCT) and four prospective cohort studies, evaluating outcomes of 1884 knees, were included. Eleven RCTs were evaluated to be low overall risk of bias, five RCTs had some concerns and four cohort studies were good quality. Few studies showed benefits of tourniquet use in mid-term implant stability (1/6), pain (1/11) and limb inflammation (1/5), and long-term implant stability (1/1). One study reported a significantly improved range of motion (1/14) while another reported significantly reduced quadriceps strength (1/6) in the tourniquet group. The remaining studies reported non-significant effect of tourniquet use. Conclusion: Although few studies indicated benefits of tourniquet use in mid-term pain, limb inflammation, implant loosening and function, and long-term implant loosening, the majority of studies report no significant advantage of tourniquet use in total knee arthroplasty.

Original languageEnglish
Article number42
JournalJournal of Experimental Orthopaedics
Volume9
Issue number1
DOIs
Publication statusPublished - Dec 2022

Keywords

  • Long-term outcome
  • TKA
  • Total knee arthroplasty
  • Total knee replacement
  • Tourniquet

Fingerprint

Dive into the research topics of 'The mid-term and long-term effects of tourniquet use in total knee arthroplasty: systematic review'. Together they form a unique fingerprint.

Cite this