Risk of serious complications during knee replacement 73% higher when a tourniquet is used

December 08, 2020

The risk of developing serious complications following a knee replacement could be up to 73% higher when a tourniquet is used, compared to surgery without a tourniquet.

Serious complications during knee replacement surgery are rare. However, researchers at the University of Warwick found that 5.9% of patients whose operations involved a tourniquet had serious complications needing additional health care, compared to 2.9% in those operated on without a tourniquet.

Research from Warwick Clinical Trials Unit has revealed that this common surgery, performed over 100,000 times a year in the UK, is likely to be safer and less painful for patients if surgeons do not use a tourniquet. A tourniquet is a device which is wrapped around the thigh and squeezes it to stop blood flow to the rest of the leg. It is typically applied for about an hour during the surgery.

The conclusions are drawn from a new systematic review publishing today (8 December) in the Cochrane Library and funded by the National Institute for Health Research, drawing on data from 41 previous clinical trials on the use of a tourniquet during knee replacement surgery. The differences became clear when the results from multiple studies around the world were combined.

The researchers conclude that surgeons should now discuss the benefits and risks of using a tourniquet with patients prior to surgery and offer a choice of whether to use a tourniquet or not. The report suggests that a change of surgical practice by not using a tourniquet might avoid up to 1,987 serious complications in the UK each year.

Many people with arthritis are successfully treated with painkillers, exercise and physiotherapy. When arthritis becomes severe, these may be less effective and patients are typically offered knee replacement surgery. This procedure is performed under anaesthetic when the knee joint is opened up, the worn joint surfaces are removed and replaced with artificial surfaces usually constructed from metal and plastic.

Widespread use of tourniquets may relate to surgeons' concerns about blood loss and improving the way that the cement used to hold the knee replacement in place attaches to the bone. However, modern anaesthetic and surgical techniques mean this is unlikely to be a problem. For example, hip and shoulder replacement surgery where the use of a tourniquet is not possible proceed safely, without undue concerns about bleeding or cement fixation of the components. The researchers found no evidence of any problem with the attachment between the cement and the bone when a tourniquet was not used, even in x-ray studies designed to measure this accurately.

The researchers pooled data from 41 previous randomised control trials up to March 2020, involving 2,819 patients, comparing the outcomes when the surgeon used a tourniquet during knee replacement surgery to those who didn't use a tourniquet. Knee function, quality of life, total blood loss and fixation of the components were measured and little difference was found between the two methods. However, where a tourniquet was used 5.9% of patients experienced serious complications such as blood clots, wound infection and the need for further surgery, compared to 2.9% where a tourniquet was not used. Patients who had a knee replacement where a tourniquet was used also reported on average 19% more pain the day after surgery than patients where no tourniquet was used.

Senior author Mr Peter Wall, Consultant Orthopaedic Surgeon from Warwick Clinical Trials Unit and University Hospitals Coventry and Warwickshire NHS Trust, said: "The evidence indicates that knee replacement surgery performed with a tourniquet increases the risk of serious complications needing additional healthcare, many of which might be avoided if a tourniquet is not used.

He emphasised that: "Most people do very well after knee replacement, but like any major surgery, there are risks and use of a tourniquet may exacerbate these."
-end-
Notes to editors:

For interviews or a copy of the paper contact:

Peter Thorley
Media Relations Manager (Warwick Medical School and Department of Physics) | Press & Media Relations | University of Warwick
Email: peter.thorley@warwick.ac.uk
Mob: +44 (0) 7824 540863

The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR supports applied health research for the direct and primary benefit of people in low- and middle-income countries, using UK aid from the UK government.

Cochrane is a global independent network of researchers, professionals, patients, carers and people interested in health. Cochrane produces reviews which study all of the best available evidence generated through research and make it easier to inform decisions about health. These are called systematic reviews. Cochrane is a not-for profit organization with collaborators from more than 130 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Our work is recognized as representing an international gold standard for high quality, trusted information.

Find out more at cochrane.org

Follow on twitter @cochranecollab

University of Warwick

Related Pain Articles from Brightsurf:

Pain researchers get a common language to describe pain
Pain researchers around the world have agreed to classify pain in the mouth, jaw and face according to the same system.

It's not just a pain in the head -- facial pain can be a symptom of headaches too
A new study finds that up to 10% of people with headaches also have facial pain.

New opioid speeds up recovery without increasing pain sensitivity or risk of chronic pain
A new type of non-addictive opioid developed by researchers at Tulane University and the Southeast Louisiana Veterans Health Care System accelerates recovery time from pain compared to morphine without increasing pain sensitivity, according to a new study published in the Journal of Neuroinflammation.

The insular cortex processes pain and drives learning from pain
Neuroscientists at EPFL have discovered an area of the brain, the insular cortex, that processes painful experiences and thereby drives learning from aversive events.

Pain, pain go away: new tools improve students' experience of school-based vaccines
Researchers at the University of Toronto and The Hospital for Sick Children (SickKids) have teamed up with educators, public health practitioners and grade seven students in Ontario to develop and implement a new approach to delivering school-based vaccines that improves student experience.

Pain sensitization increases risk of persistent knee pain
Becoming more sensitive to pain, or pain sensitization, is an important risk factor for developing persistent knee pain in osteoarthritis (OA), according to a new study by researchers from the Université de Montréal (UdeM) School of Rehabilitation and Hôpital Maisonneuve Rosemont Research Centre (CRHMR) in collaboration with researchers at Boston University School of Medicine (BUSM).

Becoming more sensitive to pain increases the risk of knee pain not going away
A new study by researchers in Montreal and Boston looks at the role that pain plays in osteoarthritis, a disease that affects over 300 million adults worldwide.

Pain disruption therapy treats source of chronic back pain
People with treatment-resistant back pain may get significant and lasting relief with dorsal root ganglion (DRG) stimulation therapy, an innovative treatment that short-circuits pain, suggests a study presented at the ANESTHESIOLOGY® 2018 annual meeting.

Sugar pills relieve pain for chronic pain patients
Someday doctors may prescribe sugar pills for certain chronic pain patients based on their brain anatomy and psychology.

Peripheral nerve block provides some with long-lasting pain relief for severe facial pain
A new study has shown that use of peripheral nerve blocks in the treatment of Trigeminal Neuralgia (TGN) may produce long-term pain relief.

Read More: Pain News and Pain Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.