JOA - 2026-07-06 - Journal Article
Tourniquet Use in Cemented Total Knee Arthroplasty: Small Gains in Fixation, No Clear Benefit in Aseptic Loosening. A Systematic Review and Meta-Analysis.
Klincke V, Descamps T, Tampere T, Arnout N, Victor J, Vermue H
Topics
Key Takeaway
Tourniquet use in cemented primary TKA reduced all-cause revision (RR 1.38 without TQ, 95% CI 1.18–1.61) but did not reduce aseptic loosening rates or improve RSA migration at 12–24 months.
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Summary
This PRISMA 2020-compliant meta-analysis compared cemented primary TKA performed with versus without tourniquet across 26 studies and 54,561 knees. Tourniquet use was associated with greater cumulative tibial baseplate cement penetration (6-zone MD: 0.92 mm; 10-zone MD: 2.59 mm) and lower all-cause revision risk (RR 1.38 without TQ), but no differences were found in RSA/MTPM at 12 or 24 months, radiolucent lines, or revision specifically for aseptic loosening. The dissociation between cement penetration gains and aseptic loosening rates precludes a causal claim for tourniquet-driven fixation benefit.
Key Limitation
The all-cause revision outcome pools heterogeneous failure modes (infection, instability, fracture) across registry and RCT data without stratification, making it impossible to determine whether the RR 1.38 reflects a true fixation advantage or confounding by indication.
Original Abstract
BACKGROUND
The effect of tourniquet (TQ) use in primary total knee arthroplasty (TKA) on implant fixation and survival remains uncertain. This review evaluated fixation and revision outcomes after TKA performed with versus without TQ.
METHODS
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, three databases were searched up to September 26, 2025. Comparative studies of primary cemented TKA were included if one group was operated on with and another without the use of a TQ. Outcomes were cement penetration, radiostereometric analysis (RSA)/maximum total point motion (MTPM), radiolucent lines (RLLs), aseptic loosening, and revision. Random-effects meta-analyses generated mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CI). There were 26 studies comprising 54,561 knees (13,540 no TQ, 40,931 full TQ, and 90 partial TQ) included.
RESULTS
The use of a TQ was associated with greater cumulative tibial baseplate cement penetration (six zones: MD: -0.92 mm (95% CI [-1.77 to -0.08]), P = 0.03; 10 zones: MD: -2.59 mm (95% CI [-4.67 to -0.52]), P = 0.01), while most femoral and isolated tibial zones did not differ. There were no between-group differences found in RSA/MTPM studies at 12 or 24 months as well as in RRL studies. All-cause revision at three to 12 years was modestly higher without a TQ (RR: 1.38 (95% CI [1.18 to 1.61]), P < 0.0001), whereas the rate of revision for and diagnosis of aseptic loosening did not differ.
CONCLUSION
The use of a tourniquet in primary cemented TKA was associated with reduced all-cause revision, but not with consistently improved radiographic fixation and cement penetration or a reduced rate of aseptic loosening, which limits causal interpretation.