Association of tourniquet use on short-term implant survival after primary total knee arthroplasty: a study of 24,249 knees from the Norwegian Arthroplasty Register
Background and purpose: Tourniquet use in total knee arthroplasty (TKA) provides a bloodless surgical field, which may lead to a better cementation but reduced function and increased pain. We aimed to investigate the effect of a tourniquet during TKA on implant survival, implant loosening, infectio...
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Medical Journals Sweden
2025-07-01
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| Series: | Acta Orthopaedica |
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| Online Access: | https://actaorthop.org/actao/article/view/43981 |
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| author | Michelle Khan Stein Håkon Låstad Lygre Mona Badawy Otto Schnell Husby Geir Hallan Paul Johan Høl Jan-Erik Gjertsen Ove Furnes |
| author_facet | Michelle Khan Stein Håkon Låstad Lygre Mona Badawy Otto Schnell Husby Geir Hallan Paul Johan Høl Jan-Erik Gjertsen Ove Furnes |
| author_sort | Michelle Khan |
| collection | DOAJ |
| description |
Background and purpose: Tourniquet use in total knee arthroplasty (TKA) provides a bloodless surgical field, which may lead to a better cementation but reduced function and increased pain. We aimed to investigate the effect of a tourniquet during TKA on implant survival, implant loosening, infection, and mortality.
Methods: Data from 24,249 TKAs, collected by the Norwegian Arthroplasty Register between 2019 and 2023, was included. Among these, 14,926 were operated on with tourniquet and 9,323 without tourniquet. Cumulative revision rates (CRRs) were estimated using 1 minus Kaplan–Meier estimates for all revision causes and Cumulative Incidence Function (CIF) for specific revision causes at 3 years of follow-up. Cox regression analyses estimated hazard rate ratios (HRRs) for all revisions and Fine and Gray analyses estimated sub-hazard ratios (SHRs) for specific revision causes. Both were adjusted for age, sex, diagnosis, ASA score, fixation, implant type, and tranexamic acid use.
Results: At 3 years of follow-up CRR was lower for the tourniquet group at 2.49% (95% confidence interval [CI] 2.21–2.81) vs 3.59% (CI 3.14–4.10) for the non-tourniquet group. We found an increased risk of revision in the non-tourniquet group (HRR 1.81, CI 1.46–2.46) after 3 months. CIF demonstrated a lower CRR for aseptic tibial loosening for the tourniquet group (0.08%, CI 0.04–0.15) compared with the non-tourniquet group (0.39%, CI 0.25–0.58). There was a higher risk of aseptic tibial loosening for non-tourniquet TKAs (SHR 6.06, CI 3.06–12.00), but no association with aseptic femoral loosening. There was no difference in infection or mortality.
Conclusion: Tourniquet use during TKA was associated with reduced risk of tibial loosening after 3 years but without increased risk of infection, femoral loosening, or mortality.
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| format | Article |
| id | doaj-art-b9bc96200c1f4013b0df1f106ca28d5b |
| institution | DOAJ |
| issn | 1745-3674 1745-3682 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Medical Journals Sweden |
| record_format | Article |
| series | Acta Orthopaedica |
| spelling | doaj-art-b9bc96200c1f4013b0df1f106ca28d5b2025-08-20T03:14:03ZengMedical Journals SwedenActa Orthopaedica1745-36741745-36822025-07-019610.2340/17453674.2025.43981Association of tourniquet use on short-term implant survival after primary total knee arthroplasty: a study of 24,249 knees from the Norwegian Arthroplasty RegisterMichelle Khan0Stein Håkon Låstad Lygre1Mona Badawy2https://orcid.org/0000-0001-6529-1484Otto Schnell Husby3Geir Hallan4Paul Johan Høl5https://orcid.org/0000-0002-4216-7891Jan-Erik Gjertsen6https://orcid.org/0000-0002-8490-268XOve Furnes7https://orcid.org/0000-0001-8223-2515epartment of Clinical Medicine, University of Bergen, Bergen, NorwayThe Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; Department of Occupational Medicine, Haukeland University Hospital, Bergen, NorwayThe Coastal Hospital at Hagevik, Hagevik, NorwayDepartment of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim; Department of Orthopaedic Surgery, Health Møre and Romsdal HF, Kristiansund Hospital, Kristiansund, NorwayDepartment of Clinical Medicine, University of Bergen, Bergen; The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; The Coastal Hospital at Hagevik, Hagevik, NorwayDepartment of Clinical Medicine, University of Bergen, Bergen; Department of Orthopaedic Surgery, Biomatlab, Haukeland University Hospital, Bergen, NorwayDepartment of Clinical Medicine, University of Bergen, Bergen; The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, NorwayDepartment of Clinical Medicine, University of Bergen, Bergen; The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway Background and purpose: Tourniquet use in total knee arthroplasty (TKA) provides a bloodless surgical field, which may lead to a better cementation but reduced function and increased pain. We aimed to investigate the effect of a tourniquet during TKA on implant survival, implant loosening, infection, and mortality. Methods: Data from 24,249 TKAs, collected by the Norwegian Arthroplasty Register between 2019 and 2023, was included. Among these, 14,926 were operated on with tourniquet and 9,323 without tourniquet. Cumulative revision rates (CRRs) were estimated using 1 minus Kaplan–Meier estimates for all revision causes and Cumulative Incidence Function (CIF) for specific revision causes at 3 years of follow-up. Cox regression analyses estimated hazard rate ratios (HRRs) for all revisions and Fine and Gray analyses estimated sub-hazard ratios (SHRs) for specific revision causes. Both were adjusted for age, sex, diagnosis, ASA score, fixation, implant type, and tranexamic acid use. Results: At 3 years of follow-up CRR was lower for the tourniquet group at 2.49% (95% confidence interval [CI] 2.21–2.81) vs 3.59% (CI 3.14–4.10) for the non-tourniquet group. We found an increased risk of revision in the non-tourniquet group (HRR 1.81, CI 1.46–2.46) after 3 months. CIF demonstrated a lower CRR for aseptic tibial loosening for the tourniquet group (0.08%, CI 0.04–0.15) compared with the non-tourniquet group (0.39%, CI 0.25–0.58). There was a higher risk of aseptic tibial loosening for non-tourniquet TKAs (SHR 6.06, CI 3.06–12.00), but no association with aseptic femoral loosening. There was no difference in infection or mortality. Conclusion: Tourniquet use during TKA was associated with reduced risk of tibial loosening after 3 years but without increased risk of infection, femoral loosening, or mortality. https://actaorthop.org/actao/article/view/43981ArthroplastyImplantsKnee |
| spellingShingle | Michelle Khan Stein Håkon Låstad Lygre Mona Badawy Otto Schnell Husby Geir Hallan Paul Johan Høl Jan-Erik Gjertsen Ove Furnes Association of tourniquet use on short-term implant survival after primary total knee arthroplasty: a study of 24,249 knees from the Norwegian Arthroplasty Register Acta Orthopaedica Arthroplasty Implants Knee |
| title | Association of tourniquet use on short-term implant survival after primary total knee arthroplasty: a study of 24,249 knees from the Norwegian Arthroplasty Register |
| title_full | Association of tourniquet use on short-term implant survival after primary total knee arthroplasty: a study of 24,249 knees from the Norwegian Arthroplasty Register |
| title_fullStr | Association of tourniquet use on short-term implant survival after primary total knee arthroplasty: a study of 24,249 knees from the Norwegian Arthroplasty Register |
| title_full_unstemmed | Association of tourniquet use on short-term implant survival after primary total knee arthroplasty: a study of 24,249 knees from the Norwegian Arthroplasty Register |
| title_short | Association of tourniquet use on short-term implant survival after primary total knee arthroplasty: a study of 24,249 knees from the Norwegian Arthroplasty Register |
| title_sort | association of tourniquet use on short term implant survival after primary total knee arthroplasty a study of 24 249 knees from the norwegian arthroplasty register |
| topic | Arthroplasty Implants Knee |
| url | https://actaorthop.org/actao/article/view/43981 |
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