Prolonged tourniquet not the right choice in total knee arth
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Total Knee Arthroplasty (TKA) is frequently undertaken with the aid of a tourniquet around the thigh. Over 90% of surgeons in the US, UK and Europe routinely use tourniquets for TKA. However, a recent study suggests prolonged tourniquet use in total knee arthroplasty surgery increases the risk of SAEs, pain, and a marginally longer hospital stay.

The aim of this study published by The Bone and Joint Journal was to determine the benefits and harms of tourniquet use in TKA surgery.

Investigators searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and trial registries up to 26 March 2020. They included randomized controlled trials (RCTs), comparing TKA with a tourniquet versus without a tourniquet. Outcomes included: pain, function, serious adverse events (SAEs), blood loss, implant stability, duration of surgery, and length of hospital stay.

Researchers included 41 RCTs with 2,819 participants. The findings were;
--SAEs were significantly more common in the tourniquet group.

--The mean pain score on the first postoperative day was 1.25 points higher in the tourniquet group.

--Overall blood loss did not differ between groups.

--The mean length of hospital stay was 0.34 days longer in the group that had surgery with a tourniquet and the mean duration of surgery was 3.7 minutes shorter.

Conclusively, TKA with a tourniquet is associated with an increased risk of SAEs, pain, and a marginally longer hospital stay. The only finding in favor of tourniquet use was a shorter time in theatre. The results make it difficult to justify the routine use of a tourniquet in TKA surgery.

Source: https://doi.org/10.1302/0301-620X.103B.BJJ-2020-1926.R1
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