Effect of tourniquet use on the risk of revision in total knee replacement surgery: an analysis of the National Joint Registry Data Set
Objective Tourniquet use in total knee replacement (TKR) is believed to improve the bone-cement interface by reducing bleeding, potentially prolonging implant survival. This study aimed to compare the risk of revision for primary cemented TKR performed with or without a tourniquet.Design We analysed...
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BMJ Publishing Group
2021-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/6/e045353.full |
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| author | Martin Underwood Andrew James Price Jane Warwick Andrew Metcalfe Muhamed M Farhan-Alanie Peter David Henry Wall Yujin Lee Mark J Wilkinson |
| author_facet | Martin Underwood Andrew James Price Jane Warwick Andrew Metcalfe Muhamed M Farhan-Alanie Peter David Henry Wall Yujin Lee Mark J Wilkinson |
| author_sort | Martin Underwood |
| collection | DOAJ |
| description | Objective Tourniquet use in total knee replacement (TKR) is believed to improve the bone-cement interface by reducing bleeding, potentially prolonging implant survival. This study aimed to compare the risk of revision for primary cemented TKR performed with or without a tourniquet.Design We analysed data from the National Joint Registry (NJR) for all primary cemented TKRs performed in England and Wales between April 2003 and December 2003. Kaplan-Meier plots and Cox regression were used to assess the influence of tourniquet use, age at time of surgery, sex and American Society of Anaesthesiologists (ASA) classification on risk of revision for all-causes.Results Data were available for 16 974 cases of primary cemented TKR, of which 16 132 had surgery with a tourniquet and 842 had surgery without a tourniquet. At 10 years, 3.8% had undergone revision (95% CI 2.6% to 5.5%) in the no-tourniquet group and 3.1% in the tourniquet group (95% CI 2.8% to 3.4%). After adjusting for age at primary surgery, gender and primary ASA score, the HR for all-cause revision for cemented TKR without a tourniquet was 0.82 (95% CI 0.57 to 1.18).Conclusions We did not find evidence that using a tourniquet for primary cemented TKR offers a clinically important or statistically significant reduction in the risk of all-cause revision up to 13 years after surgery. Surgeons should consider this evidence when deciding whether to use a tourniquet for cemented TKR. |
| format | Article |
| id | doaj-art-d06575cf897a4d24b40220a48feee639 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-d06575cf897a4d24b40220a48feee6392024-11-20T02:00:08ZengBMJ Publishing GroupBMJ Open2044-60552021-06-0111610.1136/bmjopen-2020-045353Effect of tourniquet use on the risk of revision in total knee replacement surgery: an analysis of the National Joint Registry Data SetMartin Underwood0Andrew James Price1Jane Warwick2Andrew Metcalfe3Muhamed M Farhan-Alanie4Peter David Henry Wall5Yujin Lee6Mark J Wilkinson7University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK4 University of Oxford, Oxford, UKPatient Representative, Coventry, UKClinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UKClinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UKRoyal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UKClinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UKDepartment of Oncology and Metabolism, The University of Sheffield, Sheffield, UKObjective Tourniquet use in total knee replacement (TKR) is believed to improve the bone-cement interface by reducing bleeding, potentially prolonging implant survival. This study aimed to compare the risk of revision for primary cemented TKR performed with or without a tourniquet.Design We analysed data from the National Joint Registry (NJR) for all primary cemented TKRs performed in England and Wales between April 2003 and December 2003. Kaplan-Meier plots and Cox regression were used to assess the influence of tourniquet use, age at time of surgery, sex and American Society of Anaesthesiologists (ASA) classification on risk of revision for all-causes.Results Data were available for 16 974 cases of primary cemented TKR, of which 16 132 had surgery with a tourniquet and 842 had surgery without a tourniquet. At 10 years, 3.8% had undergone revision (95% CI 2.6% to 5.5%) in the no-tourniquet group and 3.1% in the tourniquet group (95% CI 2.8% to 3.4%). After adjusting for age at primary surgery, gender and primary ASA score, the HR for all-cause revision for cemented TKR without a tourniquet was 0.82 (95% CI 0.57 to 1.18).Conclusions We did not find evidence that using a tourniquet for primary cemented TKR offers a clinically important or statistically significant reduction in the risk of all-cause revision up to 13 years after surgery. Surgeons should consider this evidence when deciding whether to use a tourniquet for cemented TKR.https://bmjopen.bmj.com/content/11/6/e045353.full |
| spellingShingle | Martin Underwood Andrew James Price Jane Warwick Andrew Metcalfe Muhamed M Farhan-Alanie Peter David Henry Wall Yujin Lee Mark J Wilkinson Effect of tourniquet use on the risk of revision in total knee replacement surgery: an analysis of the National Joint Registry Data Set BMJ Open |
| title | Effect of tourniquet use on the risk of revision in total knee replacement surgery: an analysis of the National Joint Registry Data Set |
| title_full | Effect of tourniquet use on the risk of revision in total knee replacement surgery: an analysis of the National Joint Registry Data Set |
| title_fullStr | Effect of tourniquet use on the risk of revision in total knee replacement surgery: an analysis of the National Joint Registry Data Set |
| title_full_unstemmed | Effect of tourniquet use on the risk of revision in total knee replacement surgery: an analysis of the National Joint Registry Data Set |
| title_short | Effect of tourniquet use on the risk of revision in total knee replacement surgery: an analysis of the National Joint Registry Data Set |
| title_sort | effect of tourniquet use on the risk of revision in total knee replacement surgery an analysis of the national joint registry data set |
| url | https://bmjopen.bmj.com/content/11/6/e045353.full |
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