Effect Between First Half And Entire Applying Of Tourniquet In Total Knee Arthroplasty:a Systematic Review And Meta-Analysis

Objective: Applying systematic review and Meta-analysis,evaluating the effect between releasing tourniquet after the prosthesis been put in place before electric coagulation hemostasis and after incision close with bandaging in total knee arthroplasty(TKA).Methods: Pre-designed logical retrieval types have been employed respectively to retrieve randomized controlled trials about various methods of applying tourniquet in TKA surgery among China Science and Technology periodical database(VIP),Wanfang Data Knowledge Service Platform,China National Knowledge Infrastructure(CNKI),the China Biology Medicine disc(CBM),PubMed,EMBASE,EBSCO,Web of Science,and the Cochrane Library with computer,then collecting all the randomized controlled trialsis on the basis of inclusion criteria and making a comparison,at last analyzing the heterogeneity,performing meta-analysis and graphing forest plot with the RevMan 5.3 software.Results: A total of 24 literatures were retrieved in this analysis,included 11 literatures in English and 13 literatures in Chinese,they are all randomized controlled trials applied with tourniquet in total knee arthroplasty,the total number of patients is 2539,group with first half applying of tournique included 1287 cases,group with entire applying of tournique included1252 cases.Meta analysis showed that group with first half applying of tournique can reduce postoperative hospital stay(SMD = 0.42,95% CI:[0.81,0.03],P = 0.04),reduce the incidence of postoperative DVT(RR = 0.53,95% CI:[0.40,0.70],P < 0.0001),reduce the 3 days postoperative circumference 10 cm above patellar(SMD = 0.64,95% CI:[0.96,0.32],P < 0.0001)and improve the 7 days postoperative knee HSS score(SMD = 0.99,95% CI:[0.28,1.70],P = 0.006),but increased the operation time(SMD = 0.92,95% CI:[0.54,1.30],P < 0.00001).And the incidence of postoperative superficial infection of incision(RR = 0.68,95%CI:[0.31,1.52],P = 0.35),incidence of postoperative incision deepinfection(RR = 0.99,95%CI:[0.20,4.83],P = 0.99),incidence of skin blisters around incision(RR = 0.32,95%CI:[0.03,3.04],P = 0.32),incidence of skin ecchymosis around incision(RR = 0.56,95%CI:[0.27,1.19],P = 0.13),incidence of incision hematoma(RR = 0.50,95%CI:[0.13,1.95],P = 0.32),5 days postoperative ROM(SMD = 0.65,95%CI:[-0.11,1.42],P = 0.10),7 days postoperative VAS score(SMD =-0.36,95%CI:[-0.78,0.07],P = 0.10),total blood loss(SMD =-0.31,95%CI:[-0.66,0.04],P = 0.08),postoperative Hb reduction(SMD = 0.21,95%CI:[-0.06,0.49],P = 0.13),postoperative HCT reduction(SMD =-0.05,95%CI:[-0.46,0.36],P = 0.81)and postoperative blood transfusion(RR = 0.98,95%CI:[0.72,1.34],P = 0.92)were not statistically significant.Conclusion: In this research,analysis of extracted data shows that compared with releasing tourniquet after incision close with bandaging,releasing tourniquet after the prosthesis been put in place before electric coagulation hemostasis can reduce postoperative hospital stay,reduce the incidence of postoperative DVT,reduce postoperative knee swelling and improve short-term postoperative knee function,but increased the operation time.However,take the quality of retrieved literatures,publication bias into consideration,more randomized controlled trials with high-quality,multicenter,double-blind are still required to support this conclusion.