Cochrane tourniquet TKA review

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

Does using a tourniquet during total knee replacement affect pain, function and complications?

Design

Cochrane systematic review and meta-analysis of randomised trials.

Patients

Adults undergoing total knee replacement.

Intervention

Tourniquet use

Comparison

No tourniquet

Primary outcome

Pain, function and serious adverse events

Key result

Tourniquet use was associated with a higher risk of serious adverse events (such as venous thromboembolism and infection) and slightly worse early postoperative pain, with little or no functional benefit.

Limitations

Included trials were mostly small with variable quality, inconsistent tourniquet protocols and short follow-up.

Impact on practice

Challenges routine tourniquet use in TKA; many surgeons now minimise or avoid tourniquet use, and further UK trial evidence has been sought.