Tourniquet use in total knee arthroplasty: a meta-analysis

Ta-Wei Tai, Chii-Jeng Lin, I-Ming Jou, Chih-Wei Chang, Kuo-An Lai, Chyun-Yu Yang, Ta-Wei Tai, Chii-Jeng Lin, I-Ming Jou, Chih-Wei Chang, Kuo-An Lai, Chyun-Yu Yang

Abstract

Purpose: The use of an intraoperative tourniquet for total knee arthroplasty (TKA) is a common practice. However, the effectiveness and safety are still questionable. A systematic review was conducted to examine that whether using a tourniquet in TKA was effective without increasing the risk of complications.

Methods: A comprehensive literature search was done in PubMed Medicine, Embase, and other internet database. The review work and the following meta-analysis were processed to evaluate the role of tourniquet in TKA.

Results: Eight randomized controlled trials and three high-quality prospective studies involving 634 knees and comparing TKA with and without the use of a tourniquet were included in this analysis. The results demonstrated that using a tourniquet could decrease the measured blood loss but could not decrease the calculated blood loss, which indicated actual blood loss. Patients managed with a tourniquet might have higher risks of thromboembolic complications. Using the tourniquet with late release after wound closure could shorten the operation time; whereas early release did not show this benefit.

Conclusions: The current evidence suggested that using tourniquet in TKA may save time but may not reduce the blood loss. Due to the higher risks of thromboembolic complications, we should use a tourniquet in TKA with caution.

Figures

Fig. 1
Fig. 1
a Total measured blood loss: The pooling data of the five studies favored using a tourniquet. However, Harvey et al. [7] had an extreme result. The total measured blood loss in the non-tourniquet group was twice that in the tourniquet group (1,493 versus 709 ml) probably because of cementless technique and prolonged surgical time. After taking out this result, the pooling data of the remaining studies showed no significant difference. b Calculated blood loss: The pooling results revealed slightly less calculated blood loss in the non-tourniquet group. c Intraoperative blood loss: All of five studies showed that using a tourniquet significantly decreased blood loss during the operation. The mean intraoperative blood loss in operations without a tourniquet ranged from 295 to 631 ml. d Postoperative blood loss: The pooling data revealed a slight decrease in the drained volume of the non-tourniquet group. The means of the total drained blood ranged from 290 to 528.5 ml in the tourniquet group and 145 to 661.6 ml in the non-tourniquet group. Overall, pooling date showed that using a tourniquet in TKA could reduce the intraoperative blood loss and total measured blood loss, but could not decrease the calculated blood loss
Fig. 2
Fig. 2
Results of the meta-analysis of overall clinical thromboembolic events (a) showed the risk of overall thromboembolic complications was increased by using the tourniquet, although there was no significant difference in the subgroup analysis of clinical pulmonary embolism (b) and clinical deep vein thrombosis (c). The two studies of sonographic deep vein thrombosis (d) showed different results of incidence. Fukuda et al. showed a high incidence in both groups (77.8% (21/27) in the tourniquet group and 85.7% (18/21) in the non-tourniquet group, respectively), whereas the other study reported a low incidence (1/37 in the tourniquet group and 0/40 in the non-tourniquet group, respectively)
Fig. 3
Fig. 3
Results of meta-analysis of operation time and the following subgroup analysis. Three studies with early release of tourniquet showed no difference between tourniquet and non-tourniquet groups. Five studies with late release of tourniquet showed shorter operation time in tourniquet group

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