When it comes to revision total knee arthroplasty (TKA), do the upsides of tourniquet use outweigh the risks? This is what a team from Massachusetts General Hospital and Harvard Medical School set out to determine via a retrospective review.
Are TKA tourniquets Worth the Risk? New Study From Mass Gen
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#totalkneearthroplastySecondary#tourniquet#bloodloss
Their study, “Outcomes of Tourniquet-Less Revision Total Knee Arthroplasty: A Matched Cohort Analysis,” and appears in the May 26, 2021 edition of the Journal of the American Academy of Orthopaedic Surgeons.
Co-author Young-Min Kwon, M.D., Ph.D. told OTW, “The 2018 annual survey by the American Association of Hip and Knee Surgeons (AAHKS) revealed that over 87% of its members use tourniquets for TKA procedures. The perceived benefits of using a tourniquet include reduced intraoperative blood loss and better visualization of the periprosthetic soft tissue and bone structure, which facilitate more efficient and shorter procedures.”
“However, the use of a tourniquet has been associated with potential disadvantages including increased readmissions, vascular complications, long-term nerve damage and delayed quadriceps function. Therefore, it remains debatable whether the benefits of tourniquet use outweigh the potential risks for patient outcomes.”
“As there was a paucity of data that explore the potential effect of tourniquet-use on outcomes in revision TKA, we aimed to evaluate the postoperative clinical outcomes and complications associated with tourniquet use in revision TKA.”
The researchers created two cohorts based on usage of a pneumatic tourniquet.
- 1,138 (77.2%) tourniquet-assisted TKA and
- 336 (22.8%) tourniquet-less TKA.
After propensity score matching there was a group of 548 revision TKA patients, 274 (50.0%) of whom were tourniquet patients matched to 274 (50.0%) tourniquet-less patients.
The investigtors found that the tourniquet cohort had significantly less intraoperative and total perioperative blood loss in comparison with the tourniquet-less group; there were no significant differences in total perioperative (8.4%, 6.6%) transfusion rates. The tourniquet group had an increased length of stay (3.2 to 3.7 days) and 30-day readmissions.
“We found that while omitting the tourniquet in revision TKA was associated with increased perioperative blood loss,” explained Dr. Kwon to OTW, “there was no significant differences in perioperative transfusion rates. Furthermore, revision TKA without tourniquet use was associated with significantly reduced postoperative hospital length of stay (LOS), 30-day readmissions, overall 90-day major complications, and increased range of flexion at 90 days post discharge. Our results suggest that tourniquet-less revision TKA is a viable option in selected patients.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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