Prolonged tourniquet not the right choice in total knee arthroplasty: Study

It was a systematic review and meta-analysis in which researchers MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and trial registries up to March 26, 2020. They included 41 randomized controlled trials (RCTs) with 2,819 participants, comparing TKA with a tourniquet versus without a tourniquet. The major outcomes assessed were pain, function, serious adverse events (SAEs), blood loss, implant stability, duration of surgery, and length of hospital stay.

Key findings of the study were:

• Upon analysis, they found that SAEs were significantly more common in the tourniquet group than in the non-tourniquet group. (53/901 vs 26/898, tourniquet vs no tourniquet respectively) (risk ratio of 1.73).
• They also found 1.25 points higher mean pain score on the first postoperative day in the tourniquet group.
• However, they noted that the overall blood loss did not differ between groups (mean difference 8.61 ml).
• They found that the group that had surgery with a tourniquet had a 0.34 days longer hospital stay but spent a shorter time in the operation theatre of 3.7 minutes.

The authors concluded, "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.

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DOI: https://doi.org/10.1302/0301-620X.103B.BJJ-2020-1926.R1