SynthesisKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2020
More pain and slower functional recovery when a tourniquet is used during total knee arthroplasty.
Synthesis in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
35 citing papers in PubMed, 2 syntheses or guidelines pooled it, 57 citations in OpenAlex.
- Association of Use of Tourniquets During Total Knee Arthroplasty in the Elderly Patients With Post-operative Pain and Return to Function.Frontiers in public health · 2022Pooled it
- Impact of tourniquet during knee arthroplasty: a bayesian network meta-analysis of peri-operative outcomes.Archives of orthopaedic and trauma surgery · 2021Pooled it
- Liposomal bupivacaine in peri-articular injection reduces opioid consumption and improves early prognosis of total knee arthroplasty: a randomized controlled trial.BMC musculoskeletal disorders · 2026Trial
- Trial
- Tourniquet Effect on Patients Undergoing Total Knee Arthroplasty: A Single-Blind, Randomized Controlled Trial.Orthopaedic surgery · 2024Trial
- Low tourniquet pressure has less impact on lower extremity nerve innervation: comparison of different tourniquet pressures used with intraoperative neuromonitoring with a randomized controlled study.Journal of orthopaedic surgery and research · 2024Trial
- Controlled hypotension technology can improve patient recovery in the early postoperative period after total knee arthroplasty: A prospective, randomized controlled clinical study.Joint diseases and related surgery · 2024Trial
- The Impact of Tourniquet Usage on TKA Outcome: A Single-Center Prospective Trial.Medicina (Kaunas, Lithuania) · 2023Trial
- Effect of tourniquet use on blood loss, pain, functional recovery, and complications in robot-assisted total knee arthroplasty: a prospective, double-blinded, randomized controlled trial.Journal of orthopaedic surgery and research · 2022Trial
- Topical co-delivery of platelet rich fibrin and tranexamic acid does not decrease blood loss in primary total knee arthroplasty compared to the standard of care: a prospective, randomized, controlled trial.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2021Trial
- Optimal Handling of the Patella in Tourniquet-Free Total Knee Arthroplasty: Eversion or Lateral Retraction?Orthopaedic surgery · 2020Trial
- Complications Following Aseptic Knee Revision Based on Tourniquet Use.Arthroplasty today · 2026Article
- Factors associated with early swelling after total knee arthroplasty and poor venous return : the impact of quadriceps strength, activity and preoperative anticoagulation.BMC musculoskeletal disorders · 2026Observational
- The effect of silicone ring tourniquet in anterior cruciate ligament reconstruction: a retrospective comparative study.BMC musculoskeletal disorders · 2026Article
- Comparison of robot-assisted modified subvastus approach versus medial parapatellar approach in total knee arthroplasty: a retrospective cohort study.Journal of orthopaedic surgery and research · 2026Article
- When to use a tourniquet in primary total knee arthroplasty? A systematic review and meta-analysis.Frontiers in surgery · 2026Review
- Posterior cruciate ligament reconstruction without tourniquet use reduces joint swelling without compromising surgical outcomes: a retrospective study.Scientific reports · 2025Article
- Association of tourniquet use on short-term implant survival after primary total knee arthroplasty: a study of 24,249 knees from the Norwegian Arthroplasty Register.Acta orthopaedica · 2025Article
- Advances in perioperative pain management for total knee arthroplasty: a review of multimodal analgesic approaches.Journal of orthopaedic surgery and research · 2024Review
- Effectiveness, safety and indications of acute normovolemic haemodilution in total knee arthroplasty.Scientific reports · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeAlthough a tourniquet can effectively control intraoperative blood loss and offer clear surgical field in total knee arthroplasty (TKA), its optimal usage has been controversial. The aim of this research was to perform a systematic review and meta-analysis to compare and explore the best application of a tourniquet in TKA.
methodsMEDLINE, PubMed, EMBASE, the Cochrane Library, Wanfang database, and Web of Science were searched for randomized controlled trials (RCTs) comparing the four different strategies of tourniquet application in TKA. In Group I, a tourniquet was not used and was called the non-tourniquet (NT) group. In Group II, a tourniquet was only used during the cementation of implants and was called the specific duration tourniquet (SDT) group. In Group III, the tourniquet was only released before wound closure to control the bleeding sources and was called the majority duration tourniquet (MDT) group. In Group IV, a tourniquet was used throughout the procedure, from skin incision to wound closure and was called the whole duration tourniquet (WDT) group.
resultsForty-six RCTs were included in this systematic review and meta-analysis. In a comparison between the NT and WDT groups (25 RCTs), intraoperative blood loss (IBL) (P = 0.0001) and range of motion (ROM) (P = 0.0001) were significantly increased in the NT group, while the visual analog score (VAS) (P = 0.0001), rate of deep vein thrombosis (DVT) (P = 0.01), and all complications (AC) (P = 0.0001) were significantly decreased in the NT group. In a comparison between the SDT and WDT groups (10 RCTs), IBL (P = 0.0001), TBL (P = 0.009), and ROM (P = 0.0001) were significantly increased in the SDT group, while thigh pain (P = 0.04) and the rate of DVT (P = 0.03) were significantly decreased in the SDT group. There were no significant differences between the MDT and WDT groups (12 RCTs) except for the rate of all complications (P = 0.01).
conclusionDespite the decrease in IBL with a tourniquet, no difference was found in TBL. In conclusion, not using a tourniquet or only using it during the cementation of implants was preferable based on the faster functional recovery, lower rate of DVTs and complications compared with using a tourniquet throughout the TKA procedure. LEVEL OF EVIDENCE: I.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.