Study Finds a Higher Risk of Serious Complications after TKA with Tourniquet Use

    Serious complications associated with total knee arthroplasty (TKA) are relatively rare. However, according to researchers from the University of Warwick in Coventry, UK, the risk increases by up to 73% if the surgeon uses a tourniquet during the procedure.

    Their systematic review article, published in the Cochrane Database of Systematic Reviews, draws on data from previous clinical trials on the use of a tourniquet during TKA. The difference in complications with and without the tourniquet became clear, the researchers said, when results from multiple studies around the world were combined.

    They found that that 5.9% of patients whose surgery involved a tourniquet had serious complications needing additional healthcare, compared with 2.9% of those who underwent TKA without a tourniquet.

    The researchers pooled data from 41 previous randomized control trials up to March 2020, involving 2819 patients, and compared outcomes when the surgeon used a tourniquet during TKA with outcomes for surgeons who did not use a tourniquet. This included pain, knee function, treatment success, health‐related quality of life, serious adverse events, cognitive function, and implant survival.

    When a tourniquet was used, 5.9% of patients experienced serious complications such as blood clots, wound infection, and the need for further surgery, compared with 2.9% of patients whose surgeons did not use a tourniquet. Tourniquet patients also reported on average 19% more pain the day after surgery than patients without a tourniquet.

    The researchers concluded that, “Moderate certainty evidence shows that knee replacement surgery with a tourniquet is probably associated with an increased risk of serious adverse events. Surgery with a tourniquet is also probably associated with higher postoperative pain, although this difference may or may not be noticeable to patients. Surgery with a tourniquet does not appear to confer any clinically meaningful benefit on function, treatment success or quality of life.

    “Further research is required to explore the effects of tourniquet use on cognitive function and implant survival, to identify any additional harms or benefits.”


    Ahmed I, Chawla A, Underwood M, et al. Tourniquet use for knee replacement surgery. Cochrane Database Syst Rev . 2020 Dec 8;12:CD012874. doi: 10.1002/14651858.CD012874.pub2.