Impact of tourniquet during total knee arthroplasty when tranexamic acid was used: a meta-analysis of randomized controlled trials

Abstract

Introduction The efficacy of tourniquet use during primary total knee arthroplasty (TKA) is thought to reduce intraoperative blood loss, improve surgical exposure, and optimize cement fixation. Tranexamic acid (TXA) use can decrease postsurgical blood loss and transfusion requirements. This review aimed to appraise the effects of tourniquet use in TKA for patients with tranexamic acid use. Methods A meta-analysis was conducted to identify relevant randomized controlled trials involving TXA plus a tourniquet (TXA-T group) and use of TXA plus no tourniquet (TXA-NT group) in TKA. Web of Science, PubMed, Embase, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CNKI, and Wanfang database were searched from 2010 through October 2021. Results We identified 1720 TKAs (1690 patients) assessed in 14 randomized controlled trials. Compared with the TXA-NT group, the TXA-T group resulted in less intra-operative blood loss (P < 0.00001) and decreased duration of surgery (P < 0.00001), however more hidden blood loss (P = 0.0004) and less knee range of motion (P < 0.00001). No significant differences were found between two groups in terms of decrease in hemoglobin (P = 0.84), total blood loss (P = 0.79), transfusion rate (P = 0.18), drainage volume (P = 0.06), Visual Analogue Scale (VAS) at either the day of surgery (P = 0.2), 1 day (P = 0.25), 2 day (P = 0.39), 3 day (P = 0.21), 5 day (P = 0.21), 7 day (P = 0.06) or 1 month after surgery (P = 0.16), Hospital for Special Surgery (HSS) score at either 7 day (P = 0.10), 1 month (P = 0.08), 3 month (P = 0.22) or 6 month after the surgery (P = 0.92), Knee circumference (P = 0.28), length of hospital (P = 0.12), and complications such as intramuscular venous thrombosis (P = 0.81), deep venous thrombosis (P = 0.10), superficial infection (P = 0.45), deep wound infection (P = 0.64), and delayed wound healing (P = 0.65). Conclusion No big differences could be found by using or not tourniquet when use the TXA, though some benefits are related to operation time and less intra-operative blood loss by using tourniquet and TXA, Using the tourniquet was related to more hidden blood loss and less knee range of motion. More adequately powered and better-designed randomized controlled trials (RCTs) studies with long-term follow-up are required to validate this study.

Comparison of the Utilization of Tranexamic Acid and Tourniquet Use in Total Knee Arthroplasty: A Retrospective Case Series

“…Many studies and metanalyses comparing the efficacy of TXA alone versus tourniquet alone in primary TKA have been published, as have studies comparing the use of TXA and tourniquet combined versus TXA alone in TKA [ 28 - 30 ]. However, studies comparing the two interventions alone and in combination for a total of four study groups (TXA alone, tourniquet alone, both TXA and tourniquet, no intervention) in the context of TKA are lacking in the current anesthesia literature.…”

Effectiveness and safety of tranexamic acid in total knee arthroplasty: a systematic review and meta-analysis

“…The performed meta-analysis is not without limitations. The lack of information in many studies on the use of tourniquets and the duration of their use to reduce blood loss however, these limitations in a meta-analysis of tourniquet use in knee arthroplasty found no major differences, in whether or not a tourniquet was used when using TXA during knee arthroplasty [70]. Another limitation may be the lack of knowledge about blood transfusions and blood products that affect hemoglobin levels in addition, the estimation of blood loss was variable as blood loss due to hematomas or tissue extravasation was rarely measured, which could lead to inaccurate results.…”

Podemos dispensar o uso do torniquete nas artroplastias totais do joelho?

“…O uso de torniquete na cirurgia de artroplastia total de joelho (ATJ) é frequente, pois acredita-se que melhora a visualização do campo operatório, diminui a perda intraoperatória de sangue e melhora a qualidade da cimentação. 1,2 Uma pesquisa realizada em 2009, 3 na reunião anual da American Association of Hip and Knee Surgeons, para analisar condutas médicas em cirurgias de ATJ, mostrou que o torniquete era utilizado em até 58% dos casos.…”

“…9 O propósito do torniquete, que deveria ser a redução da perda sanguínea perioperatória, já foi contestado, 10 e mostrou-se que em certos casos há aumento da perda sanguínea oculta. 1,10 Metanálises recentes demonstraram que o uso de torniquete está relacionado a um maior risco de eventos adversos graves, dor pós-operatória, maior tempo de hospitalização 1,11 e mais sangramento oculto. 1 O único achado a favorecer o uso do torniquete seria uma redução no tempo de cirurgia.…”