Tourniquet use during knee arthroplasty: A Bayesian network meta-analysis on pain, function, and thromboembolism

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Clinical Trials

Background:

• The use of tourniquets in knee arthroplasty is a subject of ongoing debate.
• Various tourniquet inflation protocols are employed, leading to inconsistent patient outcomes.
• Assessing pain, function, and thrombotic events is crucial for optimizing surgical procedures.

Purpose of the Study:

• To conduct a Bayesian network meta-analysis on tourniquet use in knee arthroplasty.
• To compare outcomes across different tourniquet protocols, including no tourniquet use.
• To evaluate the impact on pain, clinical function, and deep vein thrombosis (DVT) rates.

Main Methods:

• A systematic review and Bayesian network meta-analysis adhering to PRISMA guidelines.
• Inclusion of all clinical trials comparing tourniquet versus no-tourniquet knee arthroplasty.
• Analysis using a hierarchical random-effects model for all comparisons.

Main Results:

• Data from 54 articles involving 5497 procedures were analyzed.
• The no-tourniquet group demonstrated the lowest DVT rates.
• This group also showed superior pain management, enhanced range of motion, and higher Knee Society scores across follow-up periods.

Conclusions:

• Knee arthroplasty performed without a tourniquet yields superior overall results.
• The findings suggest a potential shift in standard practice regarding tourniquet use.
• Further research may explore specific patient populations benefiting most from no-tourniquet procedures.