Common controversies in total knee replacement surgery: Current evidence

Table 2 Studies investigating the usefulness of tourniquet use in total knee replacement

Ref.	Type of study	Outcome
Molt et al[27]	Prospective randomized controlled trial. To use a tourniquet or not. To evaluate the early migration, measured by RSA, of cemented knee prosthesis	No differences between the groups regarding the translation or rotation of the components as measured by RSA
Tarwala et al[26]	Randomized trial. To use a tourniquet only during cementation or up to wound closure	No differences in surgical time, pain scores, pain medicine requirements, range of motion, hemoglobin change, or total blood loss
Li et al[25]	Meta-analysis of randomized controlled trials. To use a tourniquet or not	Tourniquet effective for reducing intraoperative blood loss but not for reducing the postoperative blood loss and total blood loss
Olivecrona et al[24]	Randomized controlled trial. Tourniquet cuff pressure based on the patient’s systolic blood pressure or based on the measurement of the limb occlusion pressure	No differences between the groups regarding postoperative pain or complications. Tourniquet cuff pressure based on measurement of the limb occlusion pressure had less wound complications
Mittal et al[23]	Double-blind, randomized controlled trial. Tourniquet application only during cement fixation or continually	Higher risk of transfusion in the short tourniquet use group. No difference in the Oxford knee score or rate of recovery
Ledin et al[22]	Randomized trial of cemented TKR. To use a tourniquet or not	Tourniquet increased postoperative pain and reduced the range of knee motion. Tourniquet group had less overt bleeding
Alcelik et al[21]	Systematic review and meta-analysis of selected randomized controlled trials. To use a tourniquet or not	Tourniquet restricted total blood loss, but was accompanied with significantly higher rate of minor complications
Tai et al[20]	Prospective randomized trial. To use a tourniquet or not	Tourniquet effectively reduced blood and avoided excessive postoperative inflammation and muscle damage. Tourniquet group had slightly more post-op pain
Smith et al[19]	Meta-analysis of randomized and non-randomized trials. Tourniquet use or not	No advantage to using a tourniquet in knee replacement surgery for reduction of transfusion requirements
Rama et al[17]	Meta-analysis of randomized trials. Tourniquet release either before or after wound closure	Tourniquet release before wound closure increases the blood loss. However, tourniquet release after wound closure can increase the risk of early postoperative complications requiring another operation
Ishii et al[16]	Randomized trial in patients who had undergone cementless TKA. Tourniquet release either before or after wound closure	Tourniquet release before wound closure caused a significant increase in total blood loss

RSA: Radiostereometric analysis.