Peer review report 1 on “Effect of different postoperative limb positions on blood loss and range of motion in total knee arthroplasty: An updated meta-analysis of randomized controlled trials”

Abstract Background Tourniquet application is expected to improve surgery exposure and cementation process in total knee arthroplasty (TKA) but its effectiveness remains controversial and needs to be further explored. The aim of this meta-analysis was to assess the effect of tourniquet in primary TKA. The hypothesis is that the tourniquet application affects the cement penetration in TKA. Methods A search was conducted in PubMed, Embase, and the Cochrane Library for the potentially eligible articles. Two independent researchers reviewed the articles retrieved against the pre-designed inclusion and exclusion criteria. In primary TKA, cement penetration was assessed, and the data between the tourniquet-assisted and non-tourniquet-assisted TKAs were compared. Statistical significance was set at P < 0.05. Results A total of 4 randomized controlled trials and 3 non-randomized controlled trials (involving 675 patients) were included. There was no significant difference between the tourniquet-assisted and non-tourniquet-assisted TKAs in terms of cement penetration (P > 0.05). There were no significant differences in the total surgical time, blood loss, blood transfusion, the Knee Society Score, and the visual analogue scale (VAS) between the two kinds of procedures (P > 0.05). Conclusions Tourniquet application may not affect cement penetration in primary TKA and may not help reduce blood loss, ease knee pain or improve the knee function. A surgeon may choose to use a tourniquet or not according to his or her own preference. Level of Evidence Level Ib, meta-analysis.

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Sealing the Intramedullary Femoral Canal for Blood Loss in Total Knee Arthroplasty: A Meta-analysis of Randomized Controlled Trials

The Journal of Knee Surgery ◽

10.1055/s-0039-1694025 ◽

2019 ◽

Cited By ~ 1

Author(s):

Keping Wang ◽

Wenhua Yuan ◽

Jiangdong An ◽

Peng Cheng ◽

Pengjie Song ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Randomized Controlled Trials ◽

Knee Arthroplasty ◽

Meta Analysis ◽

Control Group ◽

Controlled Trials ◽

Femoral Canal ◽

Randomized Controlled ◽

Total Knee

AbstractBlood loss after total knee arthroplasty (TKA) is a potentially serious medical problem since it leads to anemia, increased need for transfusion, and prolonged hospitalization. Some studies have reported that sealing of the intramedullary femoral canal during TKA may decrease postoperative blood loss. The purpose of this study is to determine the effects of sealing of the intramedullary femoral canal during TKA on blood loss and transfusion rate. Electronic databases, PubMed, EMBASE, the Cochrane Library, Web of Science, and Chinese Biomedical Database, were systematically searched. Only randomized controlled trials (RCTs) that compared the sealing group with the control group during TKA were included up to March 2019. Two reviewers independently extracted data and assessed the quality of included studies. The statistical analysis was performed by using Review Manager 5.3 software. Cochrane Risk of Bias tool was used for quality assessment. Overall, eight RCTs involving 996 patients met our criteria and were analyzed. The results of meta-analysis showed that patients in the sealed group had less total blood loss, less total drain output and less hidden blood loss, less transfusion rates, a lower drop of hemoglobin level at day 1 postoperatively, and less hematoma than the control group. On the other hand, there were no significant differences in infection, deep vein thrombosis, and redness of incision between sealed and control group. Current meta-analysis found that sealing the femoral canal during TKA was an effective method for the control of blood loss.

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