Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Sep 10:34:250-253.
doi: 10.1016/j.jor.2022.09.003. eCollection 2022 Nov-Dec.

Defining tourniquetless total knee arthroplasty: A systematic review

David Constantinescu  1 , William Pavlis  2 , Suleiman Sudah  3 , Dennis Vanden Berge  1 , Joseph Geller  1 , Victor Hugo Hernandez  1
Affiliations
Review

Defining tourniquetless total knee arthroplasty: A systematic review

David Constantinescu et al. J Orthop. .

Abstract

Introduction: Performing total knee arthroplasty (TKA) without the use of tourniquet is gaining popularity. However, performing a "tourniquetless TKA" has a variety of meanings regarding the timing and application of a tourniquet and associated techniques. The purpose of this systematic review was to evaluate the literature and more accurately define "tourniquetless TKA."

Methods: A systematic review following PRISMA guidelines was performed of the PubMed, Web of Science, and Cochrane databases for articles published from 2016 to 2021. Inclusion criteria included papers that used "tourniquetless" or a similar term to describe their TKA procedure, original clinical studies, English language, and full-text studies.

Results: A total of 1,096 studies were identified, of which 84 full text studies with 9,349 total patients were included. Overall, 17 (20.2%) of the studies performing tourniquetless TKA never applied a tourniquet, 17 (20.2%) applied a tourniquet but kept it deflated throughout the entire procedure, 2 (2.4%) applied a tourniquet and inflated during cementation only, and 48 (57.1%) did not specify. Ultimately, of the studies that did specify tourniquet use, only 17 studies (47.2%) truly never applied a tourniquet throughout the procedure. A review of 7 recommended techniques to control blood loss in tourniquetless TKA found that no one technique was performed in more than 10.6% of patients.

Conclusion: Variation in the definition of tourniquetless TKA and the utilization of augmented techniques to control blood loss remains. We propose the terms "tourniquetless" for no tourniquet application, "tourniquet-available" for tourniquet applied but kept deflated throughout surgery, and "tourniquet-assisted" for tourniquet inflation during cementation only. These terms can help better differentiate the literature, guide surgeons as they transition to tourniquetless TKA, and assist in the development of more definitive protocols for tourniquetless TKA.

Keywords: Blood loss; Hemostasis; Systematic review; TKA; TKA, Total Knee Arthroplasty; Total knee arthroplasty; Tourniquet; Tourniquetless.

PubMed Disclaimer

Conflict of interest statement

Senior author VH declares paid consultation for Stryker, Pfizer, and Consensus, as well as roles as a voting member of the AAHKS International Committee and Editor of JBJS CME. No other authors have any financial disclosures nor declare any conflicts of interest.

Figures

Fig. 1
Fig. 1
Prisma flow diagram.
See this image and copyright information in PMC

References

    1. Zhang W., Li N., Chen S., Tan Y., Al-Aidaros M., Chen L. The effects of a tourniquet used in total knee arthroplasty: a meta-analysis. J Orthop Surg Res. 2014 Dec 6;9(1):13. - PMC - PubMed
    1. No authors listed . 2012. Swedish Knee Arthroplasty Register Annual Report 2012. Lund, Sweden.
    1. Abdel M.P., Berry D.J. Current practice trends in primary Hip and knee arthroplasties among members of the American association of Hip and knee surgeons: a long-term update. J Arthroplasty. 2019 Jul;34(7):S24–S27. - PubMed
    1. Pfitzner T., von Roth P., Voerkelius N., Mayr H., Perka C., Hube R. Influence of the tourniquet on tibial cement mantle thickness in primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2016 Jan 25;24(1):96–101. - PubMed
    1. Alcelik I., Pollock R.D., Sukeik M., Bettany-Saltikov J., Armstrong P.M., Fismer P. A comparison of outcomes with and without a tourniquet in total knee arthroplasty. J Arthroplasty. 2012 Mar;27(3):331–340. - PubMed

LinkOut - more resources