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Review
, 14 (1), 348

The Effects of Tourniquet Use on Blood Loss in Primary Total Knee Arthroplasty for Patients With Osteoarthritis: A Meta-Analysis

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Review

The Effects of Tourniquet Use on Blood Loss in Primary Total Knee Arthroplasty for Patients With Osteoarthritis: A Meta-Analysis

D F Cai et al. J Orthop Surg Res.

Abstract

Background: The tourniquet is a common medical instrument used in total knee arthroplasty (TKA). However, there has always been a debate about the use of a tourniquet and there is no published meta-analysis to study the effects of a tourniquet on blood loss in primary TKA for patients with osteoarthritis.

Methods: We performed a literature review on high-quality clinical studies to determine the effects of using a tourniquet or not on blood loss in cemented TKA. PubMed, Web of Science, MEDLINE, Embase, and the Cochrane Library were searched up to November 2018 for relevant randomized controlled trials (RCTs). We conducted a meta-analysis following the guidelines of the Cochrane Reviewer's Handbook. We used the Cochrane Collaboration's tool for assessing the risk of bias of each trial. The statistical analysis was performed with Review Manager statistical software (version 5.3).

Results: Eleven RCTs involving 541 patients (541 knees) were included in this meta-analysis. There were 271 patients (271 knees) in the tourniquet group and 270 patients (270 knees) in the no tourniquet group. The results showed that using a tourniquet significantly decreased intraoperative blood loss (P < 0.002), calculated blood loss (P < 0.002), and the time of operation (P < 0.002), but tourniquet use did not significantly decrease postoperative blood loss (P > 0.05), total blood loss (P > 0.05), the rate of transfusion (P > 0.05), and of deep vein thrombosis (DVT) (P > 0.05) in TKA.

Conclusions: Using a tourniquet can significantly decrease intraoperative blood loss, calculated blood loss, and operation time but does not significantly decrease the rate of transfusion or the rate of DVT in TKA. More research is needed to determine if there are fewer complications in TKA without the use of tourniquets.

Keywords: Blood loss; Complications; Total knee arthroplasty; Tourniquet.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart showing the selection process of randomized controlled trials
Fig. 2
Fig. 2
Risk of bias summary. Green indicates that the criterion is satisfied. Yellow indicates that it is unclear whether the criterion is satisfied or not. Red indicates that the study did not meet the criterion
Fig. 3
Fig. 3
Forest plot for intraoperative blood loss
Fig. 4
Fig. 4
Forest plot for postoperative blood loss
Fig. 5
Fig. 5
Forest plot for total blood loss
Fig. 6
Fig. 6
Forest plot for calculated blood loss
Fig. 7
Fig. 7
Forest plot for transfusion rate
Fig. 8
Fig. 8
Forest plot for DVT rate
Fig. 9
Fig. 9
Forest plot for operation time

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