The mid-term and long-term effects of tourniquet use in total knee arthroplasty: systematic review.
Long-term outcome
TKA
Total knee arthroplasty
Total knee replacement
Tourniquet
Journal
Journal of experimental orthopaedics
ISSN: 2197-1153
Titre abrégé: J Exp Orthop
Pays: Germany
ID NLM: 101653750
Informations de publication
Date de publication:
12 May 2022
12 May 2022
Historique:
received:
01
02
2022
accepted:
24
03
2022
entrez:
13
5
2022
pubmed:
14
5
2022
medline:
14
5
2022
Statut:
epublish
Résumé
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. 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. CRD42020179020. 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. 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.
Identifiants
pubmed: 35552912
doi: 10.1186/s40634-022-00471-1
pii: 10.1186/s40634-022-00471-1
pmc: PMC9098769
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
42Informations de copyright
© 2022. The Author(s).
Références
Abdel-Salam A, Eyres KS (1995) Effects of tourniquet during total knee arthroplasty. A prospective randomised study. J Bone Jt Surg Ser B 77:250–253. https://doi.org/10.1302/0301-620x.77b2.7706340
doi: 10.1302/0301-620x.77b2.7706340
Aglietti P, Baldini A, Vena LM et al (2000) Effect of tourniquet use on activation of coagulation in total knee replacement. Clin Orthop Relat Res 371:169–177. https://doi.org/10.1097/00003086-200002000-00021
doi: 10.1097/00003086-200002000-00021
Ahmed I, Chawla A, Underwood M et al (2020) Tourniquet use for knee replacement surgery. Cochrane Database Syst Rev 2020:CD012874. https://doi.org/10.1002/14651858.CD012874.pub2
doi: 10.1002/14651858.CD012874.pub2
pmcid: 8094224
Ajnin S, Fernandes R (2020) Reduced length of stay and faster recovery after total knee arthroplasty without the use of tourniquet. J Clin Orthop Trauma 11:129–132. https://doi.org/10.1016/j.jcot.2019.08.016
doi: 10.1016/j.jcot.2019.08.016
pubmed: 32002000
Alcelik I, Pollock RD, Sukeik M et al (2012) A comparison of outcomes with and without a tourniquet in Total knee Arthroplasty. A systematic review and Meta-analysis of randomized controlled trials. J Arthroplast 27:331–340. https://doi.org/10.1016/j.arth.2011.04.046
doi: 10.1016/j.arth.2011.04.046
Alexandersson M, Wang EY, Eriksson S (2019) A small difference in recovery between total knee arthroplasty with and without tourniquet use the first 3 months after surgery: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc 27:1035–1042. https://doi.org/10.1007/s00167-018-5196-8
doi: 10.1007/s00167-018-5196-8
pubmed: 30328495
Ayik O, Demirel M, Birisik F et al (2021) The effects of tourniquet application in Total knee Arthroplasty on the recovery of thigh muscle strength and clinical outcomes. J Knee Surg 34:1057–1063. https://doi.org/10.1055/s-0040-1701454
doi: 10.1055/s-0040-1701454
pubmed: 32074652
Carr AJ, Robertsson O, Graves S et al (2012) Knee replacement. In: The Lancet. Lancet Publishing Group 379:1331–1340. https://doi.org/10.1016/S0140-6736(11)60752-6
Chaudhry EA, Aziz A, Faraz A et al (2021) Application of tourniquet does not influence early clinical outcomes after Total knee Arthroplasty. Cureus 13. https://doi.org/10.7759/cureus.12435
Dennis DA, Kittelson AJ, Yang CC et al (2016) Does tourniquet use in TKA affect recovery of lower extremity strength and function? A randomized trial. Clin Orthop Relat Res 474:69–77. https://doi.org/10.1007/s11999-015-4393-8
doi: 10.1007/s11999-015-4393-8
pubmed: 26100254
Ejaz A, Laursen AC, Jakobsen T et al (2015) Absence of a tourniquet does not affect fixation of cemented TKA: a randomized RSA study of 70 patients. J Arthroplast 30:2128–2132. https://doi.org/10.1016/j.arth.2015.05.058
doi: 10.1016/j.arth.2015.05.058
Ejaz A, Laursen AC, Kappel A et al (2014) Faster recovery without the use of a tourniquet in total knee arthroplasty. Acta Orthop 85:422–426. https://doi.org/10.3109/17453674.2014.931197
doi: 10.3109/17453674.2014.931197
pubmed: 24954487
pmcid: 4105775
Fukuda A, Hasegawa M, Kato K et al (2007) Effect of tourniquet application on deep vein thrombosis after total knee arthroplasty. Arch Orthop Trauma Surg 127:671–675. https://doi.org/10.1007/s00402-006-0244-0
doi: 10.1007/s00402-006-0244-0
pubmed: 17102960
Guanche CA (1995) Tourniquet-induced tibial nerve palsy complicating anterior cruciate ligament reconstruction. Arthrosc J Arthrosc Relat Surg 11:620–622. https://doi.org/10.1016/0749-8063(95)90143-4
doi: 10.1016/0749-8063(95)90143-4
Hasanain MS, Apostu D, Alrefaee A, Tarabichi S (2018) Comparing the effect of tourniquet vs tourniquet-less in simultaneous bilateral Total knee Arthroplasties. J Arthroplast 33:2119–2124. https://doi.org/10.1016/j.arth.2018.02.013
doi: 10.1016/j.arth.2018.02.013
Hasanain MS, Apostu D, Alrefaee A, Tarabichi S (2019) Reply to Letter to the Editor on “Comparing the Effect of Tourniquet vs Tourniquet-Less in Simultaneous Bilateral Total Knee Arthroplasties”. J Arthroplast 34:604–605
doi: 10.1016/j.arth.2018.11.021
Hegde V, Bracey DN, Johnson RM et al (2021) Tourniquet use improves cement penetration and reduces radiolucent line progression at 5 years after Total knee Arthroplasty. J Arthroplast 36:S209–S214. https://doi.org/10.1016/j.arth.2020.12.048
doi: 10.1016/j.arth.2020.12.048
Higgins JPT, Savović J, Page MJ et al (2019) Assessing risk of bias in a randomized trial. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch V (eds) Cochrane handbook for systematic reviews of interventions, pp 205–228
doi: 10.1002/9781119536604.ch8
Huang ZY, Xie XW, Li LL et al (2017) Intravenous and topical tranexamic acid alone are superior to tourniquet use for primary total knee arthroplasty : a prospective, randomized controlled trial. J Bone Jt Surg Am 99:2053–2061. https://doi.org/10.2106/JBJS.16.01525
doi: 10.2106/JBJS.16.01525
Jawhar A, Skeirek D, Stetzelberger V et al (2020) No effect of tourniquet in primary total knee arthroplasty on muscle strength, functional outcome, patient satisfaction and health status: a randomized clinical trial. Knee Surg Sports Traumatol Arthrosc 28:1045–1054. https://doi.org/10.1007/s00167-019-05646-5
doi: 10.1007/s00167-019-05646-5
pubmed: 31372679
Jawhar A, Skeirek D, Stetzelberger V, Obertacke U (2020) Influence of the tourniquet on pain and function in total knee arthroplasty: a systematic review and meta-analysis. Z Orthop Unfall 158:630–640. https://doi.org/10.1055/a-0983-3808
doi: 10.1055/a-0983-3808
pubmed: 31556080
Jawhar A, Stetzelberger V, Kollowa K, Obertacke U (2019) Tourniquet application does not affect the periprosthetic bone cement penetration in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 27:2071–2081. https://doi.org/10.1007/s00167-018-5330-7
doi: 10.1007/s00167-018-5330-7
pubmed: 30539303
Jiang FZ, Zhong HM, Hong YC, Zhao GF (2015) Use of a tourniquet in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Orthop Sci 20:110–123. https://doi.org/10.1007/s00776-014-0664-6
doi: 10.1007/s00776-014-0664-6
pubmed: 25373840
Klenerman L (1995) Is a tourniquet really necessary for knee replacement? J Bone Joint Surg Br 77:174–175
doi: 10.1302/0301-620X.77B2.7706327
Konova AB, Moeller SJ, Goldstein RZ (2013) Common and distinct neural targets of treatment: changing brain function in substance addiction. In: Neurosci Biobehav Rev https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/
Leclerc JR, Geerts WH, Desjardins L et al (1996) Prevention of venous thromboembolism after knee arthroplasty: a randomized, double-blind trial comparing enoxaparin with warfarin. Ann Intern Med 124:619–626. https://doi.org/10.7326/0003-4819-124-7-199604010-00001
doi: 10.7326/0003-4819-124-7-199604010-00001
pubmed: 8607589
Li X, Yin L, Chen ZY et al (2014) The effect of tourniquet use in total knee arthroplasty: grading the evidence through an updated meta-analysis of randomized, controlled trials. Eur J Orthop Surg Traumatol 24:973–986. https://doi.org/10.1007/s00590-013-1278-y
doi: 10.1007/s00590-013-1278-y
pubmed: 23842662
Liu D, Graham D, Gillies K, Gillies RM (2014) Effects of tourniquet use on quadriceps function and pain in total knee arthroplasty. Knee Surg Relat Res 26:207–213. https://doi.org/10.5792/ksrr.2014.26.4.207
doi: 10.5792/ksrr.2014.26.4.207
pubmed: 25505702
pmcid: 4258487
Lu C, Song M, Chen J et al (2020) Does tourniquet use affect the periprosthetic bone cement penetration in total knee arthroplasty? A meta-analysis. J Orthop Surg Res 15:602. https://doi.org/10.1186/s13018-020-02106-6
doi: 10.1186/s13018-020-02106-6
pubmed: 33308270
pmcid: 7730759
McCarthy Deering E, Hu SY, Abdulkarim A (2019) Does tourniquet use in TKA increase postoperative pain? A systematic review and Meta-analysis. Clin Orthop Relat Res 477:547–558. https://doi.org/10.1097/CORR.0000000000000572
doi: 10.1097/CORR.0000000000000572
pubmed: 30461513
McGuinness LA, Higgins JPT (2021) Risk-of-bias VISualization (robvis): an R package and shiny web app for visualizing risk-of-bias assessments. Res Synth Methods 12:55–61. https://doi.org/10.1002/jrsm.1411
doi: 10.1002/jrsm.1411
pubmed: 32336025
Mittal R, Ko V, Adie S et al (2012) Tourniquet application only during cement fixation in total knee arthroplasty: a double-blind, randomized controlled trial. ANZ J Surg 82:428–433. https://doi.org/10.1111/j.1445-2197.2012.06083.x
doi: 10.1111/j.1445-2197.2012.06083.x
pubmed: 22571508
Mochizuki T, Sato T, Blaha JD et al (2014) The clinical epicondylar axis is not the functional flexion axis of the human knee. J Orthop Sci 19:451–456. https://doi.org/10.1007/s00776-014-0536-0
doi: 10.1007/s00776-014-0536-0
pubmed: 24510360
Moher D, Shamseer L, Clarke M et al (2016) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Rev Esp Nutr Humana y Diet 20:148–160. https://doi.org/10.1186/2046-4053-4-1
doi: 10.1186/2046-4053-4-1
Molt M, Harsten A, Toksvig-Larsen S (2014) The effect of tourniquet use on fixation quality in cemented total knee arthroplasty a prospective randomized clinical controlled RSA trial. Knee 21:396–401. https://doi.org/10.1016/j.knee.2013.10.008
doi: 10.1016/j.knee.2013.10.008
pubmed: 24238650
Nishiguchi M, Takamura N, Abe Y et al (2005) Pilot study on the use of tourniquet: a risk factor for pulmonary thromboembolism after total knee arthroplasty? Thromb Res 115:271–276. https://doi.org/10.1016/j.thromres.2004.08.018
doi: 10.1016/j.thromres.2004.08.018
pubmed: 15668186
Palmer SH, Graham G (1994) Tourniquet-induced rhabdomyolysis after total knee replacement
Pinsornsak P, Pinitchanon P, Boontanapibul K (2021) Effect of different tourniquet pressure on postoperative pain and complications after Total knee Arthroplasty: a prospective, randomized controlled trial. J Arthroplast 36:1638–1644. https://doi.org/10.1016/j.arth.2020.12.049
doi: 10.1016/j.arth.2020.12.049
Rathod PA, Deshmukh AJ, Cushner FD (2015) Reducing blood loss in bilateral Total knee Arthroplasty with patient-specific instrumentation. Orthop Clin North Am 46:343–350. https://doi.org/10.1016/j.ocl.2015.02.003
doi: 10.1016/j.ocl.2015.02.003
pubmed: 26043048
Rathod P, Deshmukh A, Robinson J et al (2015) Does tourniquet time in primary Total knee Arthroplasty influence clinical recovery? J Knee Surg 28:335–342. https://doi.org/10.1055/s-0034-1388654
doi: 10.1055/s-0034-1388654
pubmed: 25180797
Rohatgi A (2019) WebPlotDigitizer. Web Plot Digit
Rorabeck CH, Kennedy JC (1980) Tourniquet-induced nerve ischemia complicating knee ligament surgery. Am J Sports Med 8:98–102. https://doi.org/10.1177/036354658000800207
doi: 10.1177/036354658000800207
pubmed: 7361991
Saunders KC, Louis DL, Weingarden SI, Waylonis GW (1979) Effect of tourniquet time on postoperative quadriceps function. Clin Orthop Relat Res 143:194–199. https://doi.org/10.1097/00003086-197909000-00034
doi: 10.1097/00003086-197909000-00034
Schneider R, Hood RW, Ranawat CS (1982) Radiologic evaluation of knee arthroplasty. Orthop Clin North Am 13:225–244. https://doi.org/10.1016/s0030-5898(20)30279-0
doi: 10.1016/s0030-5898(20)30279-0
pubmed: 7063194
Shea BJ, Reeves BC, Wells G et al (2017) AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 358. https://doi.org/10.1136/bmj.j4008
Smith TO, Hing CB (2010) Is a tourniquet beneficial in total knee replacement surgery? A meta-analysis and systematic review. Knee 17:141–147. https://doi.org/10.1016/j.knee.2009.06.007
doi: 10.1016/j.knee.2009.06.007
pubmed: 19616954
Tai TW, Lin CJ, Jou IM et al (2011) Tourniquet use in total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 19:1121–1130. https://doi.org/10.1007/s00167-010-1342-7
doi: 10.1007/s00167-010-1342-7
pubmed: 21161177
Touzopoulos P, Ververidis A, Mpogiatzis C et al (2019) The use of tourniquet may influence the cement mantle thickness under the tibial implant during total knee arthroplasty. Eur J Orthop Surg Traumatol 29:869–875. https://doi.org/10.1007/s00590-019-02369-8
doi: 10.1007/s00590-019-02369-8
pubmed: 30617921
Wakankar HM, Nicholl JE, Koka R, D’Arcy JC (1999) The tourniquet in total knee arthroplasty. A prospective, randomised study. J Bone Jt Surg Ser B 81:30–33. https://doi.org/10.1302/0301-620X.81B1.8971
doi: 10.1302/0301-620X.81B1.8971
Wells G, Shea B, O’Connell D, Peterson J (2000) The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Hosp. Res. Inst, Ottawa http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
Yi Z, Yan L, Haibo S et al (2021) Effects of tourniquet use on clinical outcomes and cement penetration in TKA when tranexamic acid administrated: a randomized controlled trial. BMC Musculoskelet Disord 22. https://doi.org/10.1186/s12891-021-03968-5
Zan PF, Yang Y, Fu D et al (2015) Releasing of tourniquet before wound closure or not in total knee arthroplasty: a meta-analysis of randomized controlled trials. J Arthroplast 30:31–37. https://doi.org/10.1016/j.arth.2014.07.034
doi: 10.1016/j.arth.2014.07.034
Zhang W, Liu A, Hu D et al (2014) Effects of the timing of tourniquet release in cemented total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res 9:125. https://doi.org/10.1186/s13018-014-0125-0
doi: 10.1186/s13018-014-0125-0
pubmed: 25467223
pmcid: 4266218
Zhao HY, Yeersheng R, Kang XW et al (2020) The effect of tourniquet uses on total blood loss, early function, and pain after primary total knee arthroplasty a prospective, randomized controlled trial. Bone Jt Res 9:322–332. https://doi.org/10.1302/2046-3758.96.BJR-2019-0180.R3
doi: 10.1302/2046-3758.96.BJR-2019-0180.R3
Zhou K, Ling T, Wang H et al (2017) Influence of tourniquet use in primary total knee arthroplasty with drainage: a prospective randomised controlled trial. J Orthop Surg Res 12:172. https://doi.org/10.1186/s13018-017-0683-z
doi: 10.1186/s13018-017-0683-z
pubmed: 29137681
pmcid: 5686948
Zhou K, Wang H, Li J et al (2017) Non-drainage versus drainage in tourniquet-free knee arthroplasty: a prospective trial. ANZ J Surg 87:1048–1052. https://doi.org/10.1111/ans.14183
doi: 10.1111/ans.14183
pubmed: 28922709