Tourniquet Use Increases Harm Without Benefit in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

BackgroundApproximately 60% of orthopaedic surgeons worldwide use tourniquets (TQ) during primary total knee arthroplasty (TKA) surgeries.Currently, there are no established guidelines or recommendations; therefore, we aimed to conduct a systematic review and meta-analysis to investigate the effects of tourniquet application. MethodsThere were three major databases (PubMed, Cochrane, and Embase) systematically searched in November 2024.Randomized controlled trials (RCTs) comparing primary total knee arthroplasty with or without a tourniquet were included.We identified 6,040 studies, from which we included 41 RCTs.From reference and citation chasing, we added 10 more eligible articles.The risk of bias was assessed using the Cochrane Risk of Bias tool version 2 (RoB2), and the level of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.For continuous outcomes, the difference between the means was used as the effect size measure, along with a 95% confidence interval (CI).In the case of dichotomous outcomes, the risk ratio with a 95% CI was used. ResultsIn the tourniquet group, we observed a significantly higher risk of deep vein thrombosis (DVT) (P < 0.0001), risk ratio: 1.60 (95% CI: 1.25 to 2.05).We did not find a significant difference in the calculated total blood loss (CBL), and there was no significant difference in the risk of transfusions, with a relative risk of 1.05 (95% CI: 0.76 to -1.44).Furthermore, we observed no significant differences in pain levels or range of motion at any given time point.We experienced a moderate to high risk of bias in most outcomes, and the strength of evidence was low to moderate after grading. ConclusionIn conclusion, the use of a tourniquet during total knee arthroplasty increases the risk of deep vein thrombosis, results in higher pain levels, and leads to a lower range of motion in the early postoperative days.However, it has no significant effect on blood loss or transfusion requirements.