Evidence map›Paper›PMID 33683139›Full record

SynthesisThe bone & joint journal2021

Time to reconsider the routine use of tourniquets in total knee arthroplasty surgery.

Imran Ahmed, Amit Chawla, Martin Underwood, Andrew J Price, Andrew Metcalfe, Charles E Hutchinson, Jane Warwick, Kate Seers, Helen Parsons, Peter D H Wall

Registry-linked trialOpen access · greenAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The bone & joint journal, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05691751 (Blood Loss Assessment in the Limited Application of Tourniquet During Primary Unilateral TKA), which is not on this map. Cited by 42 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
42citing papers in PubMed, 1 pooled it
12.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

NCT05691751 nacompletednot on this map

Blood Loss Assessment in the Limited Application of Tourniquet During Primary Unilateral TKA: a Randomized Controlled Study

TypeinterventionalSponsorDamascus UniversityRan2021 to 2022Enrolled62ConditionsArthritis Knee, Blood Loss, Arthroplasty ComplicationsArmsprimary unilateral total knee arthroplasty with limited application of tourniquet, primary unilateral total knee arthroplasty with full application of tourniquet
3 · Its place in the literature

Who cites it

42 citing papers in PubMed, 1 synthesis or guideline pooled it, 80 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 1 country.

Imran AhmedWarwick Clinical Trials Unit, University of Warwick, Coventry, UK.
Amit ChawlaSt Georges Hospital, London, UK.
Martin UnderwoodWarwick Clinical Trials Unit, University of Warwick, Coventry, UK.
Andrew J PriceNuffield Deparment of Orthopaedics, Musculoskeletal Sciences and Rheumatology, University of Oxford, Oxford, UK.
Andrew MetcalfeWarwick Clinical Trials Unit, University of Warwick, Coventry, UK.
Charles E HutchinsonWarwick Medical School, University of Warwick, Coventry, UK.
Jane WarwickWarwick Clinical Trials Unit, University of Warwick, Coventry, UK.
Kate SeersWarwick Medical School, University of Warwick, Coventry, UK.
Helen ParsonsWarwick Clinical Trials Unit, University of Warwick, Coventry, UK.
Peter D H WallWarwick Clinical Trials Unit, University of Warwick, Coventry, UK.ORCID https://orcid.org/0000-0003-3149-3373
University of Warwick · GBUniversity Hospitals Coventry and Warwickshire NHS Trust · GBNuffield Orthopaedic Centre · GBSt George's Hospital · GB

Funding

Department of Health PDF-2015-08-108
6 · The paper itself

Abstract

aimsMany surgeons choose to perform total knee arthroplasty (TKA) surgery with the aid of a tourniquet. A tourniquet is a device that fits around the leg and restricts blood flow to the limb. There is a need to understand whether tourniquets are safe, and if they benefit, or harm, patients. The aim of this study was to determine the benefits and harms of tourniquet use in TKA surgery.

methodsWe searched MEDLINE, EMBASE, Cochrane Central Register of Controlled trials, and trial registries up to 26 March 2020. We included randomized controlled trials (RCTs), comparing TKA with a tourniquet versus without a tourniquet. Outcomes included: pain, function, serious adverse events (SAEs), blood loss, implant stability, duration of surgery, and length of hospital stay.

resultsWe included 41 RCTs with 2,819 participants. SAEs were significantly more common in the tourniquet group (53/901 vs 26/898, tourniquet vs no tourniquet respectively) (risk ratio 1.73 (95% confidence interval (CI) 1.10 to 2.73). The mean pain score on the first postoperative day was 1.25 points higher (95% CI 0.32 to 2.19) in the tourniquet group. Overall blood loss did not differ between groups (mean difference 8.61 ml; 95% CI -83.76 to 100.97). The mean length of hospital stay was 0.34 days longer in the group that had surgery with a tourniquet (95% CI 0.03 to 0.64) and the mean duration of surgery was 3.7 minutes shorter (95% CI -5.53 to -1.87).

conclusionTKA with a tourniquet is associated with an increased risk of SAEs, pain, and a marginally longer hospital stay. The only finding in favour of tourniquet use was a shorter time in theatre. The results make it difficult to justify the routine use of a tourniquet in TKA surgery. Cite this article:

Indexed as

Arthroplasty, Replacement, KneeTourniquetsBlood Loss, SurgicalHemostasis, SurgicalHumansRandomized Controlled Trials as TopicRange of Motion, ArticularSerious adverse eventsTotal knee arthroplastyTourniquet

Identifiers

PMID33683139
PMCPMC8091001
OpenAlexW3133853363

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

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.