Use of a tourniquet is not associated with increased risk of venous thromboembolism after fast-track total knee arthroplasty: a prospective multicenter cohort study of 16,250 procedures

Abstract

Background and purpose: Venous thromboembolism (VTE) is a serious postoperative complication after total knee arthroplasty (TKA). Use of a tourniquet has shown conflicting results for risk of VTE after TKA. We aimed to investigate the associated risk of VTE after TKA using tourniquet in a fast-track set-up as no previous data exists.Patients and methods: We performed an observational cohort study from 9 fast-track centers including unilateral primary TKA from 2010–2017 with prospective collection of preoperative risk-factors and complete 90-day follow-up. Use of a tourniquet was registered in the Danish Knee Arthroplasty Register. Postoperative VTE was identified from health records. We performed risk analyses using a mixed-effects logistic regression model adjusting for previously identified risk factors.Results: Of the 16,250 procedures (39% males, mean age 67.9 [SD 10.0] years, median LOS 2 [interquartile range 2–3]) 12,518 (77%) were performed with a tourniquet. The annual tourniquet usage varied greatly between departments from 0% to 100%, but also within departments from 0% to 99%. There was no significant difference between the 2 groups with 52 (0.42%) VTEs in the tourniquet group vs. 25 (0.67%) in the no-tourniquet group (p = 0.06 for cumulative 90-day incidence of VTE). This association remained statistically insignificant for VTE using tourniquet after adjustment for previously identified risk factors.Conclusion: We found no association between the use of a tourniquet and increased risk of 90-day VTE after primary fast-track TKA, irrespective of the length of time for which the tourniquet was applied.

Tourniquet does not affect intraoperative kinematics during total knee arthroplasty: Results of a prospective study using a robotic assistance system

“…Newer meta-analyses that already included factors like lower pressure, tranexamic acid (TXA) and local infiltration analgesia (LIA) no longer showed significant differences in functional outcomes (range of motion (ROM), strength, achievement of 90°flexion, length of stay, etc. ), pain visual analog scale (VAS), patient-reported outcome measurements (PROMs), blood loss or adverse events such as thromboembolic events [3,7]. Recent studies advocate a 'modern' tourniquet with variable pressure, depending on systolic blood pressure, and a decreased duration of use (max.…”