Skip to main content
SpringerLink
Log in

Use of a tourniquet in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

A tourniquet is commonly used in total knee arthroplasty (TKA). However, the effectiveness and safety of tourniquets are debated. We performed this study to investigate whether patients benefit from the use of tourniquets in TKA.

Methods

The literature search was conducted using PubMed, Cochrane Library, MEDLINE, Embase, and other medical databases. After a literature search, 26 randomized controlled trials involving 1,450 knees were analyzed.

Results

Tourniquet use significantly decreased intraoperative blood loss, transfusion rate, and operation time but not postoperative blood loss, measurable total blood loss, calculated total blood loss, transfusion volume, incidence of pulmonary embolism, or duration of hospital stay. It also slowed down joint functional recovery in the short term and increased the incidence of deep vein thrombosis and other minor wound complications.

Conclusions

Data from this meta-analysis indicate that patients may benefit from the use of a tourniquet in TKA; however, it use is accompanied by disadvantages and complications. Because of the very low-evidence quality and lower grading of recommendations, assessment, development, and evaluation recommendation strength, no guidelines can be developed based on current evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14

Similar content being viewed by others

References

  1. Tai TW, Chang CW, Lai KA, Lin CJ, Yang CY. Effects of tourniquet use on blood loss and soft-tissue damage in total knee arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2012;94:2209–15.

    Article  PubMed  Google Scholar 

  2. Smith TO, Hing CB. Is a tourniquet beneficial in total knee replacement surgery? A meta-analysis and systematic review. Knee. 2010;17:141–7.

    Google Scholar 

  3. Abdel-Salam A, Eyres KS. Effects of tourniquet during total knee arthroplasty. A prospective randomised study. J Bone Joint Surg Br. 1995;77:250–3.

    CAS  PubMed  Google Scholar 

  4. Clarke MT, Longstaff L, Edwards D, Rushton N. Tourniquet-induced wound hypoxia after total knee replacement. J Bone Joint Surg Br. 2001;83:40–4.

    Article  CAS  PubMed  Google Scholar 

  5. Wauke K, Nagashima M, Kato N, Ogawa R, Yoshino S. Comparative study between thromboembolism and total knee arthroplasty with or without tourniquet in rheumatoid arthritis patients. Arch Orthop Traum Su. 2002;122:442–6.

    Google Scholar 

  6. Kato N, Nakanishi K, Yoshino S, Ogawa R. Abnormal echogenic findings detected by transesophageal echocardiography and cardiorespiratory impairment during total knee arthroplasty with tourniquet. Anesthesiology. 2002;97:1123–8.

    Article  PubMed  Google Scholar 

  7. Zhou XD, Li J, Xiong Y, Jiang LF, Li WJ, Wu LD. Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis. Int Orthop. 2013;37:2109–18.

    Article  Google Scholar 

  8. Harvey EJ, Leclerc J, Brooks CE, Burke DL. Effect of tourniquet use on blood loss and incidence of deep vein thrombosis in total knee arthroplasty. J Arthroplasty. 1997;12:291–6.

    Article  CAS  PubMed  Google Scholar 

  9. Wakankar HM, Nicholl JE, Koka R, D’Arcy JC. The tourniquet in total knee arthroplasty. A prospective, randomised study. J Bone Joint Surg Br. 1999;81:30–3.

    Article  CAS  PubMed  Google Scholar 

  10. Aglietti P, Baldini A, Vena LM, Abbate R, Fedi S, Falciani M. Effect of tourniquet use on activation of coagulation in total knee replacement. Clin Orthop Relat Res. 2000;371:169–77.

    Article  PubMed  Google Scholar 

  11. Tetro AM, Rudan JF. The effects of a pneumatic tourniquet on blood loss in total knee arthroplasty. Can J Surg. 2001;44:33–8.

    CAS  PubMed Central  PubMed  Google Scholar 

  12. Vandenbussche E, Duranthon LD, Couturier M, Pidhorz L, Augereau B. The effect of tourniquet use in total knee arthroplasty. Int Orthop. 2002;26:306–9.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Katsumata S, Nagashima M, Kato K, Tachihara A, Wauke K, Saito S, Jin E, Kawanami O, Ogawa R, Yoshino S. Changes in coagulation-fibrinolysis marker and neutrophil elastase following the use of tourniquet during total knee arthroplasty and the influence of neutrophil elastase on thromboembolism. Acta Anaesthesiol Scand. 2005;49:510–6.

    Article  CAS  PubMed  Google Scholar 

  14. Matziolis G, Drahn T, Schroder JH, Krocker D, Tuischer J, Perka C. Endothelin-1 is secreted after total knee arthroplasty regardless of the use of a tourniquet. J Orthop Res. 2005;23:392–6.

    Article  CAS  PubMed  Google Scholar 

  15. Nishiguchi M, Takamura N, Abe Y, Kono M, Shindo H, Aoyagi K. Pilot study on the use of tourniquet: a risk factor for pulmonary thromboembolism after total knee arthroplasty? Thromb Res. 2005;115:271–6.

    Article  CAS  PubMed  Google Scholar 

  16. Fukuda A, Hasegawa M, Kato K, Shi D, Sudo A, Uchida A. Effect of tourniquet application on deep vein thrombosis after total knee arthroplasty. Arch Orthop Trauma Surg. 2007;127:671–5.

    Article  PubMed  Google Scholar 

  17. Kageyama K, Nakajima Y, Shibasaki M, Hashimoto S, Mizobe T. Increased platelet, leukocyte, and endothelial cell activity are associated with increased coagulability in patients after total knee arthroplasty. J Thromb Haemost. 2007;5:738–45.

    Article  CAS  PubMed  Google Scholar 

  18. Li B, Qian QR, Wu HS, Zhao H, Lin XB, Zhu J, Weng WF. The use of a pneumatic tourniquet in total knee arthroplasty: a prospective, randomized study. Zhonghua wai ke za zhi (Chin J Surg). 2008;46:1054–7.

    Google Scholar 

  19. Burg A, Dudkiewicz I, Heller S, Salai M, Velkes S. The effects of using a tourniquet in total knee arthroplasty: a study of 77 patients. J Musculoskelet Res. 2009;12:137–42.

    Article  Google Scholar 

  20. Li B, Wen Y, Wu H, Qian Q, Lin X, Zhao H. The effect of tourniquet use on hidden blood loss in total knee arthroplasty. Int Orthop. 2009;33:1263–8.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Zhang Y, Qian QR, Wu HS, Liu HB, Li XH, Wu YL, Zhu YL. Effect of tourniquet on deep venous thrombosis after total knee arthroplasty. Zhong Hua Gu Ke Za Zhi. 2009;29:910–4.

    Google Scholar 

  22. Shen ZW, Tong PJ, Shao YG, Pan T. Clinical effects of applying a tourniquet in total knee arthroplasty on swelling and function. Zhejiang Clin Med J. 2010;3:261–2.

    Google Scholar 

  23. Yavarikia A, Amjad GG, Davoudpour K. The influence of tourniquet use and timing of its release on blood loss in total knee arthroplasty. Pak J Biol Sci. 2010;13:249–52.

    Article  CAS  PubMed  Google Scholar 

  24. Zhang FJ, Xiao Y, Liu YB, Tian X, Gao ZG. Clinical effects of applying a tourniquet in total knee arthroplasty on blood loss. Chin Med J-Peking. 2010;123:3030–3.

    Google Scholar 

  25. Bao HX, Wang JF, Chu XB, LV C, Tong PJ. Tourniquet ischemia reperfusion injury after total knee arthroplasty in clinical research. Zhong Hua Chuang Shang Gu Ke Za Zhi (Chin J Orthop Trauma). 2011;13:242–6.

    Google Scholar 

  26. Lou W, Chen JP. Effect of pneumatic tourniquet on venous nitricoxide and endothelin levels in wounded of limb of patients undergoing total knee arthroplasty. Shanghai Med J. 2011;34:286–8.

    Google Scholar 

  27. Zhou W, Liu DH, Ma GT, Gong YK, Liu JS. Relationship between pneumatic tourniquet application in total knee arthroplasty and hypercoagulability. J Clin Rehabil Tissue Eng Res. 2011;15:1541–4.

    Google Scholar 

  28. Ledin H, Aspenberg P, Good L. Tourniquet use in total knee replacement does not improve fixation, but appears to reduce final range of motion. Acta Orthopaedica. 2012;83:499–503.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Alcelik I, Pollock RD, Sukeik M, Bettany-Saltikov J, Armstrong PM, Fismer P. A comparison of outcomes with and without a tourniquet in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Arthroplasty. 2012;27:331–40.

    Article  PubMed  Google Scholar 

  30. Tai TW, Lin CJ, Jou IM, Chang CW, Lai KA, Yang CY. Tourniquet use in total knee arthroplasty: a meta-analysis. Knee Surg Sport Tr A. 2011;19:1121–30.

    Article  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Second Affiliated Hospital, Zhejiang University, School of Medicine, No. 88 Jiefang road, Hangzhou, 310009, China

    Fang-zhen Jiang

  2. Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University, School of Medicine, No. 88 Jiefang road, Hangzhou, 310009, China

    Hui-ming Zhong, Yu-cai Hong & Guang-feng Zhao

Authors
  1. Fang-zhen Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hui-ming Zhong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yu-cai Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guang-feng Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guang-feng Zhao.

Additional information

F. Jiang and H. Zhong contributed equally to this study and share first authorship.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jiang, Fz., Zhong, Hm., Hong, Yc. et al. Use of a tourniquet in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Orthop Sci 20, 110–123 (2015). https://doi.org/10.1007/s00776-014-0664-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00776-014-0664-6

Keywords

Search

Navigation