The mid‐term and long‐term effects of tourniquet use in total knee arthroplasty: systematic review
Abstract Purpose A tourniquet is routinely used during total knee arthroplasty (TKA) to reduce intra‐operative hemorrhage, though surgery without a tourniquet is becoming popular. To address concerns about the effect of blood at cement interfaces on long‐term implant stability, we conducted a system...
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| Format: | Article |
| Language: | English |
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Wiley
2022-01-01
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| Series: | Journal of Experimental Orthopaedics |
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| Online Access: | https://doi.org/10.1186/s40634-022-00471-1 |
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| author | Wardah Rafaqat Sudhesh Kumar Tashfeen Ahmad Zul Qarnain Khalid Saeed Khan Riaz Hussain Lakdawala |
| author_facet | Wardah Rafaqat Sudhesh Kumar Tashfeen Ahmad Zul Qarnain Khalid Saeed Khan Riaz Hussain Lakdawala |
| author_sort | Wardah Rafaqat |
| collection | DOAJ |
| description | Abstract Purpose A tourniquet is routinely used during total knee arthroplasty (TKA) to reduce intra‐operative hemorrhage, though surgery without a tourniquet is becoming popular. To address concerns about the effect of blood at cement interfaces on long‐term implant stability, we conducted a systematic review among patients undergoing total knee arthroplasty to determine if TKA with a tourniquet, compared to TKA without a tourniquet or with reduced tourniquet duration, is associated with better mid‐term and long‐term implant stability. Methods A literature search was conducted without language restriction in PubMed, Cochrane database and Web of Science from conception to 17th March, 2021. Prospective cohorts, randomized and observational, that compared tourniquet use with a control group, followed patients for 3 months or more and reported outcomes concerning implant stability, limb function, pain and inflammation. Article selection, quality assessment according to the Revised Cochrane risk assessment scale and Newcastle Ottawa Scale, and data extraction were conducted in duplicate. PROSPERO: CRD42020179020. Results The search yielded 4868 articles, from which 16 randomized controlled trials (RCT) and four prospective cohort studies, evaluating outcomes of 1884 knees, were included. Eleven RCTs were evaluated to be low overall risk of bias, five RCTs had some concerns and four cohort studies were good quality. Few studies showed benefits of tourniquet use in mid‐term implant stability (1/6), pain (1/11) and limb inflammation (1/5), and long‐term implant stability (1/1). One study reported a significantly improved range of motion (1/14) while another reported significantly reduced quadriceps strength (1/6) in the tourniquet group. The remaining studies reported non‐significant effect of tourniquet use. Conclusion Although few studies indicated benefits of tourniquet use in mid‐term pain, limb inflammation, implant loosening and function, and long‐term implant loosening, the majority of studies report no significant advantage of tourniquet use in total knee arthroplasty. |
| format | Article |
| id | doaj-art-8dd1cb4b29454361b5e02ff3145ac874 |
| institution | OA Journals |
| issn | 2197-1153 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Experimental Orthopaedics |
| spelling | doaj-art-8dd1cb4b29454361b5e02ff3145ac8742025-08-20T02:24:25ZengWileyJournal of Experimental Orthopaedics2197-11532022-01-0191n/an/a10.1186/s40634-022-00471-1The mid‐term and long‐term effects of tourniquet use in total knee arthroplasty: systematic reviewWardah Rafaqat0Sudhesh Kumar1Tashfeen Ahmad2Zul Qarnain3Khalid Saeed Khan4Riaz Hussain Lakdawala5Aga Khan UniversityStadium Road74800KarachiSindhPakistanAga Khan UniversityStadium Road74800KarachiSindhPakistanDepartment of SurgeryAga Khan UniversityStadium Road74800KarachiSindhPakistanAga Khan UniversityStadium Road74800KarachiSindhPakistanBeatriz Galindo ProgrammeDepartment of Preventive Medicine and Public HealthUniversity of GranadaGranadaSpainDepartment of SurgeryAga Khan UniversityStadium Road74800KarachiSindhPakistanAbstract Purpose A tourniquet is routinely used during total knee arthroplasty (TKA) to reduce intra‐operative hemorrhage, though surgery without a tourniquet is becoming popular. To address concerns about the effect of blood at cement interfaces on long‐term implant stability, we conducted a systematic review among patients undergoing total knee arthroplasty to determine if TKA with a tourniquet, compared to TKA without a tourniquet or with reduced tourniquet duration, is associated with better mid‐term and long‐term implant stability. Methods A literature search was conducted without language restriction in PubMed, Cochrane database and Web of Science from conception to 17th March, 2021. Prospective cohorts, randomized and observational, that compared tourniquet use with a control group, followed patients for 3 months or more and reported outcomes concerning implant stability, limb function, pain and inflammation. Article selection, quality assessment according to the Revised Cochrane risk assessment scale and Newcastle Ottawa Scale, and data extraction were conducted in duplicate. PROSPERO: CRD42020179020. Results The search yielded 4868 articles, from which 16 randomized controlled trials (RCT) and four prospective cohort studies, evaluating outcomes of 1884 knees, were included. Eleven RCTs were evaluated to be low overall risk of bias, five RCTs had some concerns and four cohort studies were good quality. Few studies showed benefits of tourniquet use in mid‐term implant stability (1/6), pain (1/11) and limb inflammation (1/5), and long‐term implant stability (1/1). One study reported a significantly improved range of motion (1/14) while another reported significantly reduced quadriceps strength (1/6) in the tourniquet group. The remaining studies reported non‐significant effect of tourniquet use. Conclusion Although few studies indicated benefits of tourniquet use in mid‐term pain, limb inflammation, implant loosening and function, and long‐term implant loosening, the majority of studies report no significant advantage of tourniquet use in total knee arthroplasty.https://doi.org/10.1186/s40634-022-00471-1TourniquetTotal knee arthroplastyTotal knee replacementLong‐term outcomeTKA |
| spellingShingle | Wardah Rafaqat Sudhesh Kumar Tashfeen Ahmad Zul Qarnain Khalid Saeed Khan Riaz Hussain Lakdawala The mid‐term and long‐term effects of tourniquet use in total knee arthroplasty: systematic review Journal of Experimental Orthopaedics Tourniquet Total knee arthroplasty Total knee replacement Long‐term outcome TKA |
| title | The mid‐term and long‐term effects of tourniquet use in total knee arthroplasty: systematic review |
| title_full | The mid‐term and long‐term effects of tourniquet use in total knee arthroplasty: systematic review |
| title_fullStr | The mid‐term and long‐term effects of tourniquet use in total knee arthroplasty: systematic review |
| title_full_unstemmed | The mid‐term and long‐term effects of tourniquet use in total knee arthroplasty: systematic review |
| title_short | The mid‐term and long‐term effects of tourniquet use in total knee arthroplasty: systematic review |
| title_sort | mid term and long term effects of tourniquet use in total knee arthroplasty systematic review |
| topic | Tourniquet Total knee arthroplasty Total knee replacement Long‐term outcome TKA |
| url | https://doi.org/10.1186/s40634-022-00471-1 |
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