Use of a tourniquet in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

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• 作者：Fang-zhen Jiang (1)
  Hui-ming Zhong (2)
  Yu-cai Hong (2)
  Guang-feng Zhao (2)
  
  1. Department of Plastic and Reconstructive Surgery ; Second Affiliated Hospital ; Zhejiang University ; School of Medicine ; No. 88 Jiefang road ; Hangzhou ; 310009 ; China
  2. Department of Emergency Medicine ; Second Affiliated Hospital ; Zhejiang聽University ; School of Medicine ; No. 88 Jiefang road ; Hangzhou ; 310009 ; China
  
• 刊名：Journal of Orthopaedic Science
• 出版年：2015
• 出版时间：January 2015
• 年：2015
• 卷：20
• 期：1
• 页码：110-123
• 全文大小：5,238 KB
• 参考文献：1. Tai TW, Chang CW, Lai KA, Lin CJ, Yang CY. Effects of tourniquet use on blood loss and soft-tissue damage in total knee arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2012;94:2209鈥?5. CrossRef
  2. Smith TO, Hing CB. Is a tourniquet beneficial in total knee replacement surgery? A meta-analysis and systematic review. Knee. 2010;17:141鈥?.
  3. Abdel-Salam A, Eyres KS. Effects of tourniquet during total knee arthroplasty. A prospective randomised study. J Bone Joint Surg Br. 1995;77:250鈥?.
  4. Clarke MT, Longstaff L, Edwards D, Rushton N. Tourniquet-induced wound hypoxia after total knee replacement. J Bone Joint Surg Br. 2001;83:40鈥?. CrossRef
  5. Wauke K, Nagashima M, Kato N, Ogawa R, Yoshino S. Comparative study between thromboembolism and total knee arthroplasty with or without tourniquet in rheumatoid arthritis patients. Arch Orthop Traum Su. 2002;122:442鈥?.
  6. Kato N, Nakanishi K, Yoshino S, Ogawa R. Abnormal echogenic findings detected by transesophageal echocardiography and cardiorespiratory impairment during total knee arthroplasty with tourniquet. Anesthesiology. 2002;97:1123鈥?. CrossRef
  7. Zhou XD, Li J, Xiong Y, Jiang LF, Li WJ, Wu LD. Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis. Int Orthop. 2013;37:2109鈥?8. CrossRef
  8. Harvey EJ, Leclerc J, Brooks CE, Burke DL. Effect of tourniquet use on blood loss and incidence of deep vein thrombosis in total knee arthroplasty. J Arthroplasty. 1997;12:291鈥?. CrossRef
  9. Wakankar HM, Nicholl JE, Koka R, D鈥橝rcy JC. The tourniquet in total knee arthroplasty. A prospective, randomised study. J Bone Joint Surg Br. 1999;81:30鈥?. CrossRef
  10. Aglietti P, Baldini A, Vena LM, Abbate R, Fedi S, Falciani M. Effect of tourniquet use on activation of coagulation in total knee replacement. Clin Orthop Relat Res. 2000;371:169鈥?7. CrossRef
  11. Tetro AM, Rudan JF. The effects of a pneumatic tourniquet on blood loss in total knee arthroplasty. Can J Surg. 2001;44:33鈥?.
  12. Vandenbussche E, Duranthon LD, Couturier M, Pidhorz L, Augereau B. The effect of tourniquet use in total knee arthroplasty. Int Orthop. 2002;26:306鈥?. CrossRef
  13. Katsumata S, Nagashima M, Kato K, Tachihara A, Wauke K, Saito S, Jin E, Kawanami O, Ogawa R, Yoshino S. Changes in coagulation-fibrinolysis marker and neutrophil elastase following the use of tourniquet during total knee arthroplasty and the influence of neutrophil elastase on thromboembolism. Acta Anaesthesiol Scand. 2005;49:510鈥?. CrossRef
  14. Matziolis G, Drahn T, Schroder JH, Krocker D, Tuischer J, Perka C. Endothelin-1 is secreted after total knee arthroplasty regardless of the use of a tourniquet. J Orthop Res. 2005;23:392鈥?. CrossRef
  15. Nishiguchi M, Takamura N, Abe Y, Kono M, Shindo H, Aoyagi K. Pilot study on the use of tourniquet: a risk factor for pulmonary thromboembolism after total knee arthroplasty? Thromb Res. 2005;115:271鈥?. CrossRef
  16. Fukuda A, Hasegawa M, Kato K, Shi D, Sudo A, Uchida A. Effect of tourniquet application on deep vein thrombosis after total knee arthroplasty. Arch Orthop Trauma Surg. 2007;127:671鈥?. CrossRef
  17. Kageyama K, Nakajima Y, Shibasaki M, Hashimoto S, Mizobe T. Increased platelet, leukocyte, and endothelial cell activity are associated with increased coagulability in patients after total knee arthroplasty. J Thromb Haemost. 2007;5:738鈥?5. CrossRef
  18. Li B, Qian QR, Wu HS, Zhao H, Lin XB, Zhu J, Weng WF. The use of a pneumatic tourniquet in total knee arthroplasty: a prospective, randomized study. Zhonghua wai ke za zhi (Chin J Surg). 2008;46:1054鈥?.
  19. Burg A, Dudkiewicz I, Heller S, Salai M, Velkes S. The effects of using a tourniquet in total knee arthroplasty: a study of 77 patients. J Musculoskelet Res. 2009;12:137鈥?2. CrossRef
  20. Li B, Wen Y, Wu H, Qian Q, Lin X, Zhao H. The effect of tourniquet use on hidden blood loss in total knee arthroplasty. Int Orthop. 2009;33:1263鈥?. CrossRef
  21. Zhang Y, Qian QR, Wu HS, Liu HB, Li XH, Wu YL, Zhu YL. Effect of tourniquet on deep venous thrombosis after total knee arthroplasty. Zhong Hua Gu Ke Za Zhi. 2009;29:910鈥?.
  22. Shen ZW, Tong PJ, Shao YG, Pan T. Clinical effects of applying a tourniquet in total knee arthroplasty on swelling and function. Zhejiang Clin Med J. 2010;3:261鈥?.
  23. Yavarikia A, Amjad GG, Davoudpour K. The influence of tourniquet use and timing of its release on blood loss in total knee arthroplasty. Pak J Biol Sci. 2010;13:249鈥?2. CrossRef
  24. Zhang FJ, Xiao Y, Liu YB, Tian X, Gao ZG. Clinical effects of applying a tourniquet in total knee arthroplasty on blood loss. Chin Med J-Peking. 2010;123:3030鈥?.
  25. Bao HX, Wang JF, Chu XB, LV C, Tong PJ. Tourniquet ischemia reperfusion injury after total knee arthroplasty in clinical research. Zhong Hua Chuang Shang Gu Ke Za Zhi (Chin J Orthop Trauma). 2011;13:242鈥?.
  26. Lou W, Chen JP. Effect of pneumatic tourniquet on venous nitricoxide and endothelin levels in wounded of limb of patients undergoing total knee arthroplasty. Shanghai Med J. 2011;34:286鈥?.
  27. Zhou W, Liu DH, Ma GT, Gong YK, Liu JS. Relationship between pneumatic tourniquet application in total knee arthroplasty and hypercoagulability. J Clin Rehabil Tissue Eng Res. 2011;15:1541鈥?.
  28. Ledin H, Aspenberg P, Good L. Tourniquet use in total knee replacement does not improve fixation, but appears to reduce final range of motion. Acta Orthopaedica. 2012;83:499鈥?03. CrossRef
  29. Alcelik I, Pollock RD, Sukeik M, Bettany-Saltikov J, Armstrong PM, Fismer P. A comparison of outcomes with and without a tourniquet in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Arthroplasty. 2012;27:331鈥?0. CrossRef
  30. Tai TW, Lin CJ, Jou IM, Chang CW, Lai KA, Yang CY. Tourniquet use in total knee arthroplasty: a meta-analysis. Knee Surg Sport Tr A. 2011;19:1121鈥?0. CrossRef
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Orthopedics
  Surgical Orthopedics
  Conservative Orthopedics
  Rheumatology
  Sports Medicine
  
• 出版者：Springer Japan
• ISSN：1436-2023

文摘

Background A tourniquet is commonly used in total knee arthroplasty (TKA). However, the effectiveness and safety of tourniquets are debated. We performed this study to investigate whether patients benefit from the use of tourniquets in TKA. Methods The literature search was conducted using PubMed, Cochrane Library, MEDLINE, Embase, and other medical databases. After a literature search, 26 randomized controlled trials involving 1,450 knees were analyzed. Results Tourniquet use significantly decreased intraoperative blood loss, transfusion rate, and operation time but not postoperative blood loss, measurable total blood loss, calculated total blood loss, transfusion volume, incidence of pulmonary embolism, or duration of hospital stay. It also slowed down joint functional recovery in the short term and increased the incidence of deep vein thrombosis and other minor wound complications. Conclusions Data from this meta-analysis indicate that patients may benefit from the use of a tourniquet in TKA; however, it use is accompanied by disadvantages and complications. Because of the very low-evidence quality and lower grading of recommendations, assessment, development, and evaluation recommendation strength, no guidelines can be developed based on current evidence.