title: Tourniquet use in total knee arthroplasty: a meta-analysis.
abstract: OBJECTIVE
  The use of an intraoperative tourniquet for total knee arthroplasty (TKA) is a common practice. However, the effectiveness and safety are still questionable. A systematic review was conducted to examine that whether using a tourniquet in TKA was effective without increasing the risk of complications.
  
  
  METHODS
  A comprehensive literature search was done in PubMed Medicine, Embase, and other internet database. The review work and the following meta-analysis were processed to evaluate the role of tourniquet in TKA.
  
  
  RESULTS
  Eight randomized controlled trials and three high-quality prospective studies involving 634 knees and comparing TKA with and without the use of a tourniquet were included in this analysis. The results demonstrated that using a tourniquet could decrease the measured blood loss but could not decrease the calculated blood loss, which indicated actual blood loss. Patients managed with a tourniquet might have higher risks of thromboembolic complications. Using the tourniquet with late release after wound closure could shorten the operation time; whereas early release did not show this benefit.
  
  
  CONCLUSIONS
  The current evidence suggested that using tourniquet in TKA may save time but may not reduce the blood loss. Due to the higher risks of thromboembolic complications, we should use a tourniquet in TKA with caution.
authors.affiliation: Department of Orthopaedics, National Cheng Kung University Hospital, 138 Sheng-Li Rd., Tainan, Taiwan.
authors.forename: Ta-Wei
authors.initials: TW
authors.lastname: Tai
authors.forename: Chii-Jeng
authors.initials: CJ
authors.lastname: Lin
authors.forename: I-Ming
authors.initials: IM
authors.lastname: Jou
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Chang
authors.forename: Kuo-An
authors.initials: KA
authors.lastname: Lai
authors.forename: Chyun-Yu
authors.initials: CY
authors.lastname: Yang
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001810:Blood Volume; D006488:Hemostasis, Surgical / Q000295:instrumentation*; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology; D013923:Thromboembolism / Q000453:epidemiology; D014111:Tourniquets