The impact of tourniquet on tibial bone cement penetration in different zones in primary total knee arthroplasty: a meta-analysis

Abstract

Background Cement mantle penetration and the cement–bone interface strength were critical to a successful primary total knee arthroplasty (TKA). It remained unclear whether decreased blood and fat in the cancellous bone achieved with the use of a tourniquet increases tibial cement mantle penetration in different zones on AP and lateral view in TKA according to criteria defined by the Knee Society Scoring System (KSS). The purpose of this study was to determine whether tourniquet use influences tibial cement mantle penetration in different zones on AP and lateral view in TKA according to KSS. Methods We conducted a meta-analysis to identify studies involving the impact of tourniquet use and no tourniquet use on tibial bone cement penetration in primary TKA in electronic databases, including Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, VIP, Wanfang database, up to January 2021. Finally, we identified 1231 patients (1231 knees) assessed in twelve studies. Results Tourniquet use increases the cumulative cement mantle penetration (P < 0.00001), mean cement mantle penetration (P = 0.004), and cement mantle in zone 3(P < 0.0001) on AP view. However, there were no significant differences in cement mantle in zone 1(P = 0.5), zone 2(P =0 .54), zone 4(P = 0.07) on AP view, and zone 1(P = 0.32), zone 2(P = 0.38) on lateral view between two groups. There were also no significant differences in length of surgery(P = 0.7), change in hemoglobin(P = 0.4), transfusion rates(P = 0.47), and complications such as muscular calf vein thrombosis(P = 0.21), superficial infection (P = 0.72), and deep vein thrombosis (P = 0.66) between two groups. Conclusion The application of a tourniquet increases the thickness of the tibial bone cement penetration—the increase in the thickness of bone cement penetration mainly located in zone 3 on the anteroposterior (AP) view.

Total Knee Arthroplasty: The Impact of Tourniquet Usage on Cement Penetration, Operation Time, and Bleeding Control

“…Hoffman et al reported an average cement penetration depth of 2.7 mm in their study (28). Sun et al found an increase in the thickness of tibial bone cement penetration mainly located in zone 3 on the anteroposterior (AP) view with the application of a tourniquet (29). Radiographic analysis of Rathod et al revealed no differences in cement penetration around the tibial component in any zone (30).…”

Controlled hypotension technology can improve patient recovery in the early postoperative period after total knee arthroplasty: A prospective, randomized controlled clinical study

“…In addition, bone cement penetration thickness and cement-bone interface strength are critical for successful primary TKA, and aseptic loosening of knee joint prostheses generally occurs on the tibial side; thus, the penetration thickness of bone cement around the tibial side of the prosthesis can be an effective method for predicting the survival rate of the prosthesis. [ 24 ] Overall, increasing the penetration thickness of bone cement can help increase the stability of the prosthesis. There is controversy about whether a tourniquet has an impact on the infiltration thickness of bone cement around the prosthesis,[ 25 , 26 ] and not using a tourniquet may affect the fixation strength of the joint prosthesis due to high intraoperative bleeding.…”