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Tourniquet use in total knee arthroplasty: a meta-analysis.

Tai TW, Lin CJ, Jou IM, Chang CW, Lai KA, Yang CY - Knee Surg Sports Traumatol Arthrosc (2010)

Bottom Line: However, the effectiveness and safety are still questionable.Using the tourniquet with late release after wound closure could shorten the operation time; whereas early release did not show this benefit.The current evidence suggested that using tourniquet in TKA may save time but may not reduce the blood loss.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, National Cheng Kung University Hospital, 138 Sheng-Li Rd., Tainan, Taiwan.

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.

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Related in: MedlinePlus

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)
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Fig2: 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)

Mentions: With respect to thromboembolic events after surgery, eight studies provided data on the incidence of sonographic or clinical DVT and pulmonary embolism. The pooling results found that the risk of clinical thromboembolic events was significantly higher in the tourniquet group than in the non-tourniquet group (Fig. 2a). Symptomatic thromboembolic events occurred in 13.0 and 6.1% of patients in the tourniquet and non-tourniquet group, respectively (Table 3). In the subgroup analysis, both symptomatic DVT and pulmonary embolism occurred more often in the tourniquet group than in the non-tourniquet group, although there was no statistical difference (Fig. 2b, c). One study [36] claimed there were no DVTs in either group. Two studies investigated the incidence of DVT using sonographic image examinations [5, 36]. The diversity of results indicated that the sonographic examination was operator dependent. The pooled results showed no difference between the tourniquet and non-tourniquet groups (Fig. 2d).Fig. 2


Tourniquet use in total knee arthroplasty: a meta-analysis.

Tai TW, Lin CJ, Jou IM, Chang CW, Lai KA, Yang CY - Knee Surg Sports Traumatol Arthrosc (2010)

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)
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Related In: Results  -  Collection

Show All Figures
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Fig2: 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)
Mentions: With respect to thromboembolic events after surgery, eight studies provided data on the incidence of sonographic or clinical DVT and pulmonary embolism. The pooling results found that the risk of clinical thromboembolic events was significantly higher in the tourniquet group than in the non-tourniquet group (Fig. 2a). Symptomatic thromboembolic events occurred in 13.0 and 6.1% of patients in the tourniquet and non-tourniquet group, respectively (Table 3). In the subgroup analysis, both symptomatic DVT and pulmonary embolism occurred more often in the tourniquet group than in the non-tourniquet group, although there was no statistical difference (Fig. 2b, c). One study [36] claimed there were no DVTs in either group. Two studies investigated the incidence of DVT using sonographic image examinations [5, 36]. The diversity of results indicated that the sonographic examination was operator dependent. The pooled results showed no difference between the tourniquet and non-tourniquet groups (Fig. 2d).Fig. 2

Bottom Line: However, the effectiveness and safety are still questionable.Using the tourniquet with late release after wound closure could shorten the operation time; whereas early release did not show this benefit.The current evidence suggested that using tourniquet in TKA may save time but may not reduce the blood loss.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, National Cheng Kung University Hospital, 138 Sheng-Li Rd., Tainan, Taiwan.

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.

Show MeSH
Related in: MedlinePlus