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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 3/2023

21-04-2022 | KNEE

The use of tourniquet in primary total knee arthroplasty does not increase the risk of venous thromboembolism within 90 days of surgery: a Danish nationwide cohort study of 19,804 patients

Authors: Anders El-Galaly, Anette Tarp Hansen, Andreas Kappel

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2023

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Abstract

Purpose

Existing evidence estimates a twofold risk of venous thromboembolisms (VTEs) if tourniquet is applied during total knee arthroplasties (TKAs). However, this estimate relies on multiple trials with a low number of patients analyzing VTEs as a secondary outcome. We hypothesized that tourniquet-use increases the risk of symptomatic VTE within 90 days of contemporary primary TKA and aimed to use the extensive Danish healthcare registries to quantify this risk.

Methods

Prospectively collected registry data from Danish patients receiving primary TKAs between 2014 and 2018 were included in the study. Patients were divided by tourniquet-use during surgery. By merging information from four nationwide registries, the study included 44 baseline characteristics with the potential to confound the association between tourniquet-use and VTE. Incidence rate and odds ratios were used to compare the risk of VTE within 90 days of surgery.

Results

19,804 patients of whom 10,111 (51%) were operated with tourniquet and 9693 (49%) without were included. The mean age (SD) was 70 (9) in both groups and 62% were females in the tourniquet group compared with 61% in the no tourniquet group. The groups were similarly comparable across all other baseline characteristics except type of post-operative thromboprophylaxis, type of anaesthesia, implant fixation, and year of surgery. The 90-days incidence of VTE was 0.77% (95% CI 0.60–0.94) in the tourniquet group compared with 1.10% (95% CI 0.90–1.31) in the no tourniquet group. Following adjustment for the unbalanced confounders, the odds ratio for VTE was 0.77 (95% CI 0.54–1.10) associated with tourniquet-use.

Conclusion

In contemporary TKAs the rate of VTE within 90 days is low and not significant altered by tourniquet-use. Thus, tourniquet can safely be applied during primary TKA-surgery without jeopardizing the risk of postoperative VTE.

Level of evidence

II—prospective cohort study.
Appendix
Available only for authorised users
Literature
1.
Ahmed I, Chawla A, Underwood M, Price AJ, Metcalfe A, Hutchinson C, Warwick J, Seers K, Parsons H, Wall PD (2020) Tourniquet use for knee replacement surgery. Cochrane database Syst Rev 12:CD012874PubMed
2.
Ahmed I, Chawla A, Underwood M, Price AJ, Metcalfe A, Hutchinson CE, Warwick J, Seers K, Parsons H, Wall PDH (2021) Time to reconsider the routine use of tourniquets in total knee arthroplasty surgery. Bone Jt J 103-B:830–839CrossRef
3.
Austin PC (2009) Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research. Commun Stat Simul Comput 38:1228–1234CrossRef
4.
Azur MJ, Stuart EA, Frangakis C, Leaf PJ (2011) Multiple imputation by chained equations: what is it and how does it work? Int J Methods Psychiatr Res 20:40–49CrossRefPubMedPubMedCentral
5.
Brusselaers N, Lagergren J (2017) The Charlson comorbidity index in registry-based research. Methods Inf Med 56:401–406CrossRefPubMed
6.
Cai DF, Fan QH, Zhong HH, Peng S, Song H (2019) The effects of tourniquet use on blood loss in primary total knee arthroplasty for patients with osteoarthritis: a meta-analysis. J Orthop Surg Res 14:348CrossRefPubMedPubMedCentral
7.
8.
Ejaz A, Laursen AC, Jakobsen T, Rasmussen S, Nielsen PT, Laursen MB (2015) Absence of a tourniquet does not affect fixation of cemented TKA: a randomized RSA study of 70 patients. J Arthroplasty 30:2128–2132CrossRefPubMed
9.
Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14CrossRef
10.
Jørgensen CC, Jacobsen MK, Soeballe K, Hansen TB, Husted H, Kjærsgaard-Andersen P, Hansen LT, Laursen MB, Kehlet H (2013) Thromboprophylaxis only during hospitalisation in fast-track hip and knee arthroplasty, a prospective cohort study. BMJ Open 3:e003965CrossRefPubMedPubMedCentral
11.
Kim JYS, Khavanin N, Rambachan A, McCarthy RJ, Mlodinow AS, De Oliveria Jr GS, Stock MC, Gust MJ, Mahvi DM (2015) Surgical duration and risk of venous thromboembolism. JAMA Surg 150:110–117CrossRefPubMed
12.
Lee WC, Kwan YH, Chong HC, Yeo SJ (2017) The minimal clinically important difference for Knee Society Clinical Rating System after total knee arthroplasty for primary osteoarthritis. Knee Surg Sport Traumatol Arthrosc 25:3354–3359CrossRef
13.
Liu Y, Si H, Zeng Y, Li M, Xie H, Shen B (2020) More pain and slower functional recovery when a tourniquet is used during total knee arthroplasty. Knee Surg Sport Traumatol Arthrosc 28:1842–1860CrossRef
14.
Nemeth B, Nelissen R, Arya R, Cannegieter S (2021) Preventing VTE following total hip and knee arthroplasty: is prediction the future? J Thromb Haemost 19:41–45CrossRefPubMed
15.
P. Vatcheva K, Lee M, (2016) Multicollinearity in regression analyses conducted in epidemiologic studies. Epidemiol Open Access 06:1–20
16.
Pottegård A, Schmidt SAJ, Wallach-Kildemoes H, Sørensen HT, Hallas J, Schmidt M (2017) Data resource profile: the Danish national prescription registry. Int J Epidemiol 46:798PubMed
17.
Rodgers A, Walker N, Schug S, McKee A, Kehlet H, Van Zundert A, Sage D, Futter M, Saville G, Clark T, MacMahon S (2000) Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. Br Med J 321:1493–1497CrossRef
18.
Schelde AB, Petersen J, Jensen TB, Gromov K, Overgaard S, Olesen JB, Jimenez-Solem E (2021) Validation of registration of pharmacological treatment in the Danish Hip and Knee Arthroplasty Registers. Basic Clin Pharmacol Toxicol 128:455–462CrossRefPubMed
19.
Schmidt M, Pedersen L, Sørensen HT (2014) The Danish Civil Registration System as a tool in epidemiology. Eur J Epidemiol 29:541–549CrossRefPubMed
20.
Schmidt M, Schmidt SAJ, Adelborg K, Sundbøll J, Laugesen K, Ehrenstein V, Sørensen HT (2019) The Danish health care system and epidemiological research: from health care contacts to database records. Clin Epidemiol 11:563–591CrossRefPubMedPubMedCentral
21.
Schmidt M, Schmidt SAJ, Sandegaard JL, Ehrenstein V, Pedersen L, Sørensen HT (2015) The Danish National patient registry: a review of content, data quality, and research potential. Clin Epidemiol 7:449–490CrossRefPubMedPubMedCentral
22.
Severinsen MT, Kristensen SR, Overvad K, Dethlefsen C, Tjønneland A, Johnsen SP (2010) Venous thromboembolism discharge diagnoses in the Danish National Patient Registry should be used with caution. J Clin Epidemiol 63:223–228CrossRefPubMed
23.
Sundbøll J, Adelborg K, Munch T, Frøslev T, Sørensen HT, Bøtker HE, Schmidt M (2016) Positive predictive value of cardiovascular diagnoses in the Danish National Patient Registry: a validation study. BMJ Open 6:e012832CrossRefPubMedPubMedCentral
24.
Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M, Initiative STROBE (2007) Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Epidemiology 18:805–835CrossRefPubMed
25.
Xie J, Yu H, Wang F, Jing J, Li J (2021) A comparison of thrombosis in total knee arthroplasty with and without a tourniquet: a meta-analysis of randomized controlled trials. J Orthop Surg Res 16:408CrossRefPubMedPubMedCentral
26.
Yi S, Tan J, Chen C, Chen H, Huang W (2014) The use of pneumatic tourniquet in total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg 134:1469–1476CrossRefPubMed
27.
Zhang W, Li N, Chen S, Tan Y, Al-Aidaros M, Chen L (2014) The effects of a tourniquet used in total knee arthroplasty: a meta-analysis. J Orthop Surg Res 9:13CrossRefPubMedPubMedCentral
28.
Metadata
Title
The use of tourniquet in primary total knee arthroplasty does not increase the risk of venous thromboembolism within 90 days of surgery: a Danish nationwide cohort study of 19,804 patients
Authors
Anders El-Galaly
Anette Tarp Hansen
Andreas Kappel
Publication date
21-04-2022
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-022-06965-w

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Correction

Correction to: Functional alignment with robotic‑arm assisted total knee arthroplasty demonstrated better patient‑reported outcomes than mechanical alignment with manual total knee arthroplasty