Tourniquet application in primary total knee arthroplasty for osteoarthritis: A systematic review and meta-analysis of randomized controlled trials
ObjectiveThe aim of this study was to identify the influence of a tourniquet on the blood loss, transfusion requirement, swelling, pain, knee function, range of motion (ROM), operation time, bone cement mantle thickness, and complications in patients operated with total knee arthroplasty (TKA).Metho...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-01-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2022.994795/full |
| _version_ | 1797960162494906368 |
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| author | Jinchang Han Jinchang Han Xiao-yu Zhang Xiao-yu Zhang Shi-yin Mu Shi-long Liu Shi-long Liu Qing-tong Cui Qing-tong Cui Chao Zhang Chao Zhang Ai-feng Liu Ai-feng Liu |
| author_facet | Jinchang Han Jinchang Han Xiao-yu Zhang Xiao-yu Zhang Shi-yin Mu Shi-long Liu Shi-long Liu Qing-tong Cui Qing-tong Cui Chao Zhang Chao Zhang Ai-feng Liu Ai-feng Liu |
| author_sort | Jinchang Han |
| collection | DOAJ |
| description | ObjectiveThe aim of this study was to identify the influence of a tourniquet on the blood loss, transfusion requirement, swelling, pain, knee function, range of motion (ROM), operation time, bone cement mantle thickness, and complications in patients operated with total knee arthroplasty (TKA).MethodsTwo authors independently retrieved PubMed, Embase, and CENTRAL to identify eligible randomized controlled trials (RCTs) evaluating the effectiveness of a tourniquet in TKA. Fixed- (I2 < 50%) or random-effects (I2 > 50%) models were selected to perform meta-analysis according to the value of I2. Mean difference (MD) and risk ratio were selected as the effect sizes for continuous and dichotomous variables, respectively.ResultsA total of 29 RCTs, involving 2,512 operations (1,258 procedures with a tourniquet and 1,254 procedures without a tourniquet), were included, and 18 outcomes were compared. Tourniquet application could significantly decrease intraoperative blood loss (MD = −138.72 ml, p < 0.001), shorten operation duration (MD = −1.77 min, p < 0.001), and increase cement mantle thickness (MD = 0.17 mm, p < 0.001). However, it was significantly associated with increased postoperative pain intensity, decreased full ROM/flexion ROM/extension ROM, poorer knee function, increased knee swelling, and increased length of hospital stay (LOS) at several follow-up points (p < 0.050). No significant difference was found for postoperative draining volume, total blood loss, transfusion rate, change of Hb level, and risks of deep venous thrombosis and all complications.ConclusionsTourniquet application could only decrease the intraoperative blood loss but has no effectiveness on the total blood loss and transfusion requirement. On the contrary, it has a reverse effect on the pain score, knee function, ROM, swelling, and LOS. |
| first_indexed | 2024-04-11T00:42:00Z |
| format | Article |
| id | doaj.art-f1039877fc5b4460b3680eccf6e02d71 |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-04-11T00:42:00Z |
| publishDate | 2023-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-f1039877fc5b4460b3680eccf6e02d712023-01-06T05:34:55ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2023-01-01910.3389/fsurg.2022.994795994795Tourniquet application in primary total knee arthroplasty for osteoarthritis: A systematic review and meta-analysis of randomized controlled trialsJinchang Han0Jinchang Han1Xiao-yu Zhang2Xiao-yu Zhang3Shi-yin Mu4Shi-long Liu5Shi-long Liu6Qing-tong Cui7Qing-tong Cui8Chao Zhang9Chao Zhang10Ai-feng Liu11Ai-feng Liu12Department of Orthopedics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, ChinaNational Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, ChinaDepartment of Orthopedics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, ChinaNational Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, ChinaDepartment of Respiratory of Machang, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, ChinaDepartment of Orthopedics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, ChinaNational Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, ChinaDepartment of Orthopedics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, ChinaNational Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, ChinaDepartment of Orthopedics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, ChinaNational Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, ChinaDepartment of Orthopedics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, ChinaNational Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, ChinaObjectiveThe aim of this study was to identify the influence of a tourniquet on the blood loss, transfusion requirement, swelling, pain, knee function, range of motion (ROM), operation time, bone cement mantle thickness, and complications in patients operated with total knee arthroplasty (TKA).MethodsTwo authors independently retrieved PubMed, Embase, and CENTRAL to identify eligible randomized controlled trials (RCTs) evaluating the effectiveness of a tourniquet in TKA. Fixed- (I2 < 50%) or random-effects (I2 > 50%) models were selected to perform meta-analysis according to the value of I2. Mean difference (MD) and risk ratio were selected as the effect sizes for continuous and dichotomous variables, respectively.ResultsA total of 29 RCTs, involving 2,512 operations (1,258 procedures with a tourniquet and 1,254 procedures without a tourniquet), were included, and 18 outcomes were compared. Tourniquet application could significantly decrease intraoperative blood loss (MD = −138.72 ml, p < 0.001), shorten operation duration (MD = −1.77 min, p < 0.001), and increase cement mantle thickness (MD = 0.17 mm, p < 0.001). However, it was significantly associated with increased postoperative pain intensity, decreased full ROM/flexion ROM/extension ROM, poorer knee function, increased knee swelling, and increased length of hospital stay (LOS) at several follow-up points (p < 0.050). No significant difference was found for postoperative draining volume, total blood loss, transfusion rate, change of Hb level, and risks of deep venous thrombosis and all complications.ConclusionsTourniquet application could only decrease the intraoperative blood loss but has no effectiveness on the total blood loss and transfusion requirement. On the contrary, it has a reverse effect on the pain score, knee function, ROM, swelling, and LOS.https://www.frontiersin.org/articles/10.3389/fsurg.2022.994795/fulltotal knee arthroplastytourniquetblood lossmeta-analysistransfusion requirement |
| spellingShingle | Jinchang Han Jinchang Han Xiao-yu Zhang Xiao-yu Zhang Shi-yin Mu Shi-long Liu Shi-long Liu Qing-tong Cui Qing-tong Cui Chao Zhang Chao Zhang Ai-feng Liu Ai-feng Liu Tourniquet application in primary total knee arthroplasty for osteoarthritis: A systematic review and meta-analysis of randomized controlled trials Frontiers in Surgery total knee arthroplasty tourniquet blood loss meta-analysis transfusion requirement |
| title | Tourniquet application in primary total knee arthroplasty for osteoarthritis: A systematic review and meta-analysis of randomized controlled trials |
| title_full | Tourniquet application in primary total knee arthroplasty for osteoarthritis: A systematic review and meta-analysis of randomized controlled trials |
| title_fullStr | Tourniquet application in primary total knee arthroplasty for osteoarthritis: A systematic review and meta-analysis of randomized controlled trials |
| title_full_unstemmed | Tourniquet application in primary total knee arthroplasty for osteoarthritis: A systematic review and meta-analysis of randomized controlled trials |
| title_short | Tourniquet application in primary total knee arthroplasty for osteoarthritis: A systematic review and meta-analysis of randomized controlled trials |
| title_sort | tourniquet application in primary total knee arthroplasty for osteoarthritis a systematic review and meta analysis of randomized controlled trials |
| topic | total knee arthroplasty tourniquet blood loss meta-analysis transfusion requirement |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2022.994795/full |
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