Tourniquet effect on cement penetration in total knee arthroplasty: A systematic review and meta-analysis.

Abstract

<h4>Purpose</h4>Total knee arthroplasty (TKA) is a standard orthopaedic procedure for severe knee arthritis, often resulting in high patient satisfaction. However, complications, such as aseptic loosening, remain a significant concern, some thought to be linked to insufficient cement penetration. Using a tourniquet during surgery to improve cement penetration is a topic of debate, with evidence regarding its mixed effectiveness. This review aims to evaluate the impact of tourniquet application on cement penetration, TKA outcomes and related complications.<h4>Methods</h4>A meta-analysis adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted, analyzing comparative studies from PubMed, Scopus, Web of Science and Embase. Eligibility criteria focused on studies assessing tourniquet effects on cement penetration, complications and other surgical outcomes. Data extraction and quality assessment followed standardized protocols. Statistical analyses employed a random-effects model to account for heterogeneity, including sensitivity analyses and publication bias assessments.<h4>Results</h4>The meta-analysis included 16 studies encompassing 1516 observations. Tourniquet use significantly increased cement penetration in average and cumulative analysis (<i>p</i> value = 0.045 and 0.005, respectively). Tourniquet pressure-based subgroup analysis did not show statistically significant differences in cement penetration between groups. In secondary outcomes, a 52% reduction in blood transfusion likelihood was observed in the tourniquet group-no significant differences in haemoglobin levels (standardized mean difference [SMD] = 0.0; <i>p</i> = 1). No differences were noted in surgical time (SMD = -0.152; <i>p</i> = 0.26) or postoperative pain (visual analogue scale scores; <i>p</i> = 0.184).<h4>Conclusions</h4>Tourniquet usage enhanced cement penetration but did not significantly affect surgical duration and pain; instead, it reduced blood transfusion rates. However, variability in surgical techniques and methodologies among included studies has contributed to the results. Future research must use standardized methodologies to resolve inconsistencies and confirm these results.<h4>Levels of evidence</h4>Level II.