Tourniquets increase the risk of serious complications in knee replacement surgery (16 August 2021)

Summary

Many surgeons prefer to perform total knee replacement surgery with the aid of a tourniquet. A tourniquet is an occlusive device that restricts distal blood flow to help create a bloodless field during the procedure.

This article considers the results of a review that compared knee replacement with use of a tourniquet versus without use of a tourniquet and non‐randomised studies with more than 1000 participants. It highlights the risks of complications such as blood clots and infections associated with this, and indicates that changing surgical practice to avoid using tourniquets could avoid nearly 2,000 serious complications in the UK each year.

Content

Currently approximately nine in ten surgeons use a tourniquet during knee replacement surgery. The results of the review show that tourniquets increase the risk of blood clots, infections and other complications when used in knee surgery.

This article states that while the risk is still low (the vast majority of knee replacement operations do not lead to serious complications), because it is such a common procedure, researchers estimate that changing surgical practice to avoid using tourniquets could avoid nearly 2,000 serious complications in the UK each year.

Commenting on this, Dr Benjamin Ellis, Senior Clinical Policy Advisor at Versus Arthritis, says:

“With hundreds of thousands currently waiting for joint operations due to the NHS backlog, knee replacement surgery is a lifeline that can cure the severe pain and disability caused by arthritis, which all too often robs people of their ability to work or enjoy life.

To have the best possible treatment, people with arthritis need their surgeons and other health professionals to clearly explain the procedure in a way they can understand, outline the hoped-for benefits and potential risks, and ensure that they are fully informed and involved in decisions about the care they will receive. 

Instinctively, it might seem that a tourniquet is a good idea. What this study shows though is that using a tourniquet increases complications for patients, leading to more pain after the operation, and a greater risk of blood clots and infections, which can be debilitating and even fatal – and that’s before even thinking about the increased treatment costs to health services too. So while there may be times when a tourniquet is still a good idea, it would seem they should not be used routinely. And where there may be a valid clinical reason to consider using one, then the health-care professionals must always discuss the options with the patient, and ensure they have been able to make a collaborative, shared decision.”