Cochrane tourniquet in knee replacement

Tourniquet use for knee replacement surgery.

Ahmed I, Chawla A, Underwood M, et al. The Cochrane database of systematic reviews 2020 · PMID 33316105 · doi:10.1002/14651858.cd012874.pub2

Question

What are the benefits and harms of using a tourniquet during total knee replacement?

Design

Cochrane systematic review and meta-analysis of randomised trials.

Patients

Adults having primary total knee replacement.

Intervention

Thigh tourniquet during surgery

Comparison

No tourniquet

Primary outcome

Function, pain and serious adverse events

Key result

Tourniquet use was associated with a higher risk of serious adverse events and slightly more early postoperative pain, with no meaningful gains in function and only a modest shortening of operating time.

Limitations

Included trials were mostly small, with variable tourniquet protocols and low to moderate certainty evidence.

Impact on practice

It prompted many UK surgeons to limit or stop routine tourniquet use in knee replacement and led to the UK SAFE-TKR trial.