Abstract

Purpose

The intra-operative use of tourniquets during Total Knee Arthroplasty (TKA) is common practice. The advantages of tourniquet use include decreased operating time and the creation of a bloodless visualisation field. However, tourniquet use has recently been linked with increased post-operative pain, reduced range of motion, and slower functional recovery. Importantly, there is limited evidence of the effect of tourniquet use on infection risk. The purpose of this systematic review and meta-analysis is to fill this gap in the literature by synthesising data pertaining to the association between tourniquet use and infection risk in TKA.

Methods

A systematic literature search was performed on Pubmed, Embase, Cochrane and clinicaltrials.gov up to May 2021. Randomized control trials were included, comparing TKA outcomes with and without tourniquet use. The primary outcome was overall infection rate. Secondary outcomes included superficial and deep infection, skin necrosis, skin blistering, DVT rate, and transfusion rate.

Results

14 RCTs with 1329 patients were included. The pooled incidence of infection in the tourniquet group (4.0%, 95% CI = 2.7–5.4) was significantly higher compared to the non-tourniquet group (2.0%, 95% CI = 1.1–3.1) with an OR of 1.9 (95% CI = 1.1–3.76, p = 0.03). The length of hospital stay, haemoglobin drop (0.33 95% CI =0.12–0.54), P = 0.002) and transfusion rates (OR of 2.7, 95%CI = 1.4–5.3, P = < 0.01) were higher in the tourniquet group than the non-tourniquet group. The difference in the length of inhospital stay was 0.24 days favouring the non-tourniquet group (95% CI = 0.10–0.38, P = < 0.01). The incidence of skin blistering (OR 2.6, 95% CI = 0.7–9.9, p = 0.17), skin necrosis (OR 3.0, 95% CI = 0.50–19.3, p = 0.25), and DVT rates (OR 1.5, 95% CI = 0.60–3.60, p = 0.36) did not differ between the two groups.

Conclusion

Quantitative synthesis of the data suggested tourniquet use was associated with an increased overall risk of infection, intraoperative blood loss, need for blood transfusion and longer hospital stay. Findings of this meta-analysis do not support the routine use of tourniquet in TKA and arthroplasty surgeons should consider any potential additional risks associated with its use.

Level of evidence

meta-analysis, Level II.

Details

Title
Tourniquet use in total knee arthroplasty and the risk of infection: a meta-analysis of randomised controlled trials
Author
Magan, A. A. 1   VIAFID ORCID Logo  ; Dunseath, O. 2 ; Armonis, P. 2 ; Fontalis, A. 3 ; Kayani, B. 3 ; Haddad, F. S. 4 

1  University College Hospital, Department of Trauma and Orthopaedic Surgery, London, UK (GRID:grid.439749.4) (ISNI:0000 0004 0612 2754); The Princess Grace Hospital, Department of Orthopaedic Surgery, London, UK (GRID:grid.439666.8) (ISNI:0000 0004 0579 6319) 
2  University College London, London, UK (GRID:grid.83440.3b) (ISNI:0000000121901201) 
3  University College Hospital, Department of Trauma and Orthopaedic Surgery, London, UK (GRID:grid.439749.4) (ISNI:0000 0004 0612 2754) 
4  University College Hospital, Department of Trauma and Orthopaedic Surgery, London, UK (GRID:grid.439749.4) (ISNI:0000 0004 0612 2754); The Princess Grace Hospital, Department of Orthopaedic Surgery, London, UK (GRID:grid.439666.8) (ISNI:0000 0004 0579 6319); University College London, London, UK (GRID:grid.83440.3b) (ISNI:0000000121901201); University College Hospital, Institute of Sports, Health and Exercise, London, UK (GRID:grid.439749.4) (ISNI:0000 0004 0612 2754) 
Publication year
2022
Publication date
Dec 2022
Publisher
Springer Nature B.V.
e-ISSN
21971153
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1186/s40634-022-00485-9
ProQuest document ID
2682992682
Copyright
© The Author(s) 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.