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Tourniquet Use Increases Harm Without Benefit in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis
Andras Zoltan Posta1, Nandor Jozsef Nemes2, Shota Takanouchi3
1Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Orthopedics Clinic, Semmelweis University, Budapest, Hungary.
Background:
Approximately 60% of orthopaedic surgeons worldwide use tourniquets during primary total knee arthroplasty (TKA) surgeries. Currently, there are no established guidelines or recommendations; therefore, we aimed to conduct a systematic review and meta-analysis to investigate the effects of tourniquet application.
Methods:
There were three major databases (PubMed, Cochrane, and Embase) systematically searched in November 2024. Randomized controlled trials comparing primary TKA with or without a tourniquet were included. We identified 6,040 studies, from which we included 41 randomized controlled trials. From reference and citation chasing, we added 10 more eligible articles. The risk of bias was assessed using the Cochrane Risk of Bias tool version 2, and the level of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. For continuous outcomes, the difference between the means was used as the effect size measure, along with a 95% confidence interval (CI). In the case of dichotomous outcomes, the risk ratio with a 95% CI was used.
Results:
In the tourniquet group, we observed a significantly higher risk of deep vein thrombosis (P < 0.0001), risk ratio: 1.60 (95% CI: 1.25 to 2.05). We did not find a significant difference in the calculated total blood loss, and there was no significant difference in the risk of transfusions, with a relative risk of 1.05 (95% CI: 0.76 to -1.44). Furthermore, we observed no significant differences in pain levels or range of motion at any given time point. We experienced a moderate to high risk of bias in most outcomes, and the strength of evidence was low to moderate after grading.
Conclusions:
The use of a tourniquet during TKA increases the risk of deep vein thrombosis, results in higher pain levels, and leads to a lower range of motion in the early postoperative days. However, it has no significant effect on blood loss or transfusion requirements.
