Defining tourniquetless total knee arthroplasty: A systematic review

Area of Science:

• Orthopedic Surgery
• Surgical Techniques

Background:

• Tourniquetless total knee arthroplasty (TKA) is increasingly popular.
• The definition and application of
• tourniquetless TKA
• vary significantly in current literature.
• Lack of standardized terminology hinders clear understanding and adoption of the technique.

Purpose of the Study:

• To systematically review the literature and establish a precise definition for
• tourniquetless TKA
• .
• To evaluate the various meanings and techniques associated with tourniquetless TKA procedures.

Main Methods:

• A systematic review adhering to PRISMA guidelines was conducted.
• Searched PubMed, Web of Science, and Cochrane databases for studies published between 2016 and 2021.
• Included original clinical studies in English that used terms like
• tourniquetless TKA
• .

Main Results:

• Out of 1,096 identified studies, 84 full-text studies involving 9,349 patients were included.
• A significant portion of studies (57.1%) did not specify tourniquet usage details.
• Among studies that specified usage, only 47.2% truly performed TKA without any tourniquet application.

Conclusions:

• There is considerable variation in defining and implementing tourniquetless TKA.
• Proposed terms:
• tourniquetless
• (no tourniquet),
• tourniquet-available
• (tourniquet applied but deflated), and
• tourniquet-assisted
• (tourniquet used during cementation only).
• These definitions aim to clarify the literature, guide surgeons, and aid in developing standardized protocols for tourniquetless TKA.