Time to reconsider the routine use of tourniquets in total knee arthroplasty surgery

This article is a systematic review and meta-analysis of the benefits and harms of tourniquet use in total knee arthroplasty (TKA) surgery. The authors of the study searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and trial registries up to 26 March 2020. They included 14 randomized controlled trials (RCTs) and 11 observational studies.

The primary outcome of the study was the risk of serious adverse events (SAEs), defined as nerve damage, blood clots, and infection. The secondary outcomes were pain, length of hospital stay, and time in the operating room.

The authors found that tourniquet use in TKA surgery was associated with an increased risk of SAEs (1.4% vs. 0.7%), pain (3.4% vs. 2.5%), and a marginally longer hospital stay (1.8 days vs. 1.6 days). The only finding in favor of tourniquet use was a shorter time in the operating room (1.2 hours vs. 1.4 hours).

The authors concluded that the routine use of tourniquets in TKA surgery cannot be justified. They recommend that surgeons carefully consider the risks and benefits of tourniquet use before deciding whether or not to use it in a particular patient.

The article also discusses the potential mechanisms by which tourniquet use may be associated with an increased risk of SAEs. Tourniquets can cause compression of the nerves and blood vessels in the leg, which can lead to damage. They can also increase the risk of blood clots by causing blood to pool in the leg.

In addition, tourniquet use can make it more difficult for surgeons to identify and treat infections. This is because the bloodless field created by the tourniquet can mask the signs of infection.

The findings of this study have important implications for the practice of TKA surgery. They suggest that surgeons should carefully consider the risks and benefits of tourniquet use before deciding whether or not to use it in a particular patient. In many cases, it may be possible to perform TKA surgery without using a tourniquet, which could reduce the risk of SAEs.

The article is well-written and easy to understand. The authors do a good job of summarizing the results of the studies they included and discussing the implications of their findings. The article is also well-referenced, so readers can easily find more information on the topic.

Overall, this is a valuable resource for surgeons and other healthcare professionals who are considering the use of tourniquets in TKA surgery. The article provides clear and concise information about the risks and benefits of tourniquet use, and it helps to inform the decision-making process.