Using a tourniquet during knee replacement surgery increases the risk of serious complications and post-operative abdominal pain, according to new research from the University of Warwick.
A systematic meta-analysis carried out by researchers at the Warwick Clinical Trials Unit revealed that the procedure is likely to be safer and less painful for patients if surgeons do not use a tourniquet.
The researchers pooled data from 41 previous randomised control trials (n=2819) published up to March 2020, which compared outcomes of knee replacement with and without the use of a tourniquet.
The evidence showed no difference between the two approaches in terms of knee function, quality of life, total blood loss and fixation of the components. There was no evidence of any problem with the attachment between the cement and the bone when a tourniquet was not used.
However, where a tourniquet was used, 5.9 per cent of patients experienced serious complications such as blood clots, wound infection and the need for further surgery, compared with 2.9 per cent where a tourniquet was not used. Patients reported on average 19 per cent more pain the day after surgery when a tourniquet was used.
Based on the data, the researchers concluded that surgeons should discuss the benefits and risks of using a tourniquet with patients prior to surgery and offer a choice of whether to use a tourniquet or not. The report suggests that a change of surgical practice by not using a tourniquet might avoid up to 1987 serious complications in the UK each year.
Senior author Mr Peter Wall, Consultant Orthopaedic Surgeon at University Hospitals Coventry and Warwickshire NHS Trust, said: "The evidence indicates that knee replacement surgery performed with a tourniquet increases the risk of serious complications needing additional healthcare, many of which might be avoided if a tourniquet is not used."
