Association of tourniquet use on short-term implant survival after primary total knee arthroplasty: a study of 24,249 knees from the Norwegian Arthroplasty Register.

Background and purpose:  Tourniquet use in total knee arthroplasty (TKA) provides a bloodless surgical field, which may lead to a better cementation but reduced function and increased pain. We aimed to investigate the effect of a tourniquet during TKA on implant survival, implant loosening, infection, and mortality.

Methods:  Data from 24,249 TKAs, collected by the Norwegian Arthroplasty Register between 2019 and 2023, was included. Among these, 14,926 were operated on with tourniquet and 9,323 without tourniquet. Cumulative revision rates (CRRs) were estimated using 1 minus Kaplan-Meier estimates for all revision causes and Cumulative Incidence Function (CIF) for specific revision causes at 3 years of follow-up. Cox regression analyses estimated hazard rate ratios (HRRs) for all revisions and Fine and Gray analyses estimated sub-hazard ratios (SHRs) for specific revision causes. Both were adjusted for age, sex, diagnosis, ASA score, fixation, implant type, and tranexamic acid use.

Results:  At 3 years of follow-up CRR was lower for the tourniquet group at 2.49% (95% confidence interval [CI] 2.21-2.81) vs 3.59% (CI 3.14-4.10) for the non-tourniquet group. We found an increased risk of revision in the non-tourniquet group (HRR 1.81, CI 1.46-2.46) after 3 months. CIF demonstrated a lower CRR for aseptic tibial loosening for the tourniquet group (0.08%, CI 0.04-0.15) compared with the non-tourniquet group (0.39%, CI 0.25-0.58). There was a higher risk of aseptic tibial loosening for non-tourniquet TKAs (SHR 6.06, CI 3.06-12.00), but no association with aseptic femoral loosening. There was no difference in infection or mortality.

Conclusion:  Tourniquet use during TKA was associated with reduced risk of tibial loosening after 3 years but without increased risk of infection, femoral loosening, or mortality.