title: Effects of the timing of tourniquet release in cemented total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  The aim of this study is to evaluate the effects of tourniquet release before wound closure for hemostasis or after wound closure in cemented total knee arthroplasty (TKA).
  
  
  METHODS
  We conducted a meta-analysis and review work on relevant clinical outcomes to evaluate the effects of the timing of tourniquet release in cemented TKA. Electronic databases were searched for relevant randomized controlled trials (RCTs) that compared outcomes of tourniquet release before wound closure for hemostasis with tourniquet release after wound closure. The methodological quality of each included RCT was assessed in terms of the 12-item scale. The meta-analysis was performed with STATA 12.0 software.
  
  
  RESULTS
  Eleven RCTs involving 651 patients with 670 TKAs were included in this meta-analysis. Of these, 332 patients (342 knees) were in an early tourniquet release group and 319 patients (328 knees) in the late tourniquet release group. The results showed that there were no significant differences in overt blood loss, hemoglobin drop, and blood transfusions, whereas the tourniquet release after wound closure might increase the risks of overall complications and major complications.
  
  
  CONCLUSIONS
  Tourniquet release before wound closure for hemostasis might reduce the rate of complications, but it could not limit overall blood loss. The current evidences are not enough to indicate that tourniquet release before wound closure is superior to its release after wound closure in cemented TKA.
authors.affiliation: Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China. zhangweilook@zju.edu.cn.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China. liuan@zju.edu.cn.
authors.forename: An
authors.initials: A
authors.lastname: Liu
authors.affiliation: Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, China. 117494316@qq.com.
authors.forename: Dongcai
authors.initials: D
authors.lastname: Hu
authors.affiliation: Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, China. 313237115@qq.com.
authors.forename: Yang
authors.initials: Y
authors.lastname: Tan
authors.affiliation: Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, China. sheher@hotmail.com.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Aidaros
authors.affiliation: Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China. panzhijunzw@163.com.
authors.forename: Zhijun
authors.initials: Z
authors.lastname: Pan
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data; D006489:Hemostatic Techniques; D006801:Humans; D014111:Tourniquets / Q000009:adverse effects