Abstract
BackgroundThe purpose of this research is to evaluate the effects of a tourniquet in total knee arthroplasty (TKA).MethodsThe study was done by randomized controlled trials (RCTs) on the effects of a tourniquet in TKA. All related articles which were published up to June 2013 from Medline, Embase, and Cochrane Central Register of Controlled Trails were identified. The methodological quality of the included studies was assessed by the Physiotherapy Evidence Database (PEDro) scale. The meta-analysis was performed using Cochrane RevMan software version 5.1.ResultsThirteen RCTs that involved a total of 689 patients with 689 knees were included in the meta-analysis, which were divided into two groups. The tourniquet group included 351 knees and the non-tourniquet group included 338 knees. The meta-analysis showed that using a tourniquet in TKA could reduce intraoperative blood loss (weighted mean difference (WMD), -198.21; 95% confidence interval (CI), -279.82 to -116.60; P < 0.01) but did not decrease the calculated blood loss (P = 0.80), which indicates the actual blood loss. Although TKA with a tourniquet could save the operation time for 4.57 min compared to TKA without a tourniquet (WMD, -4.57; 95% CI, -7.59 to -1.56; P < 0.01), it had no clinical significance. Meanwhile, the use of tourniquet could not reduce the possibility of blood transfusion (P > 0.05). Postoperative knee range of motion (ROM) in tourniquet group was 10.41° less than that in the non-tourniquet group in early stage (≤10 days after surgery) (WMD, -10.41; 95% CI, -16.41 to -4.41; P < 0.01). Moreover, the use of a tourniquet increased the risk of either thrombotic events (risk ratio (RR), 5.00; 95% CI, 1.31 to 19.10; P = 0.02) or non-thrombotic complications (RR, 2.03; 95% CI, 1.12 to 3.67; P = 0.02).ConclusionsTKA without a tourniquet was superior to TKA with a tourniquet in thromboembolic events and the other related complications. There were no significant differences between the two groups in the actual blood loss. TKA with a tourniquet might hinder patients' early postoperative rehabilitation exercises.
Highlights
The purpose of this research is to evaluate the effects of a tourniquet in total knee arthroplasty (TKA)
The following criteria were required for inclusion: (1) patients underwent unilateral primary TKA, (2) a randomized controlled trials (RCTs) comparing patients undergoing TKA with or without a tourniquet, (3) patients suffering from primary osteoarthritis (OA) or rheumatoid arthritis (RA), and (4) full text must be published in English
In Padala et al.'s study, the nontourniquet group received 2.5 mg of adrenaline diluted in 500 ml of normal saline which was infiltrated into the skin, subcutaneous tissues, and capsule before surgical incision
Summary
The purpose of this research is to evaluate the effects of a tourniquet in total knee arthroplasty (TKA). Total knee arthroplasty (TKA) is commonly performed using a tourniquet. A recent survey reported that 95% of the members of the American Association of Hip and Knee surgeons used a tourniquet for TKA [1]. Some studies reported that several complications were associated with the use of a tourniquet in TKA, including skin blistering, wound hematoma, wound ooze, muscle injury, rhabdomyolysis, nerve palsy, postoperative stiffness, deep vein thrombosis (DVT), and pulmonary embolism (PE) [3,4,5,6,7,8,9,10]. There were some reports of severe and fatal complications following TKA with a tourniquet, which included pulmonary edema [11], renal failure [10], and PE that led to death in some cases
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