SYSTEMATIC REVIEW article
Front. Surg.
Sec. Orthopedic Surgery
This article is part of the Research TopicJoint Arthroplasty Failure: from Diagnosis to Revision SurgeryView all articles
When to use a tourniquet in primary total knee arthroplasty? A systematic review and meta-analysis
Provisionally accepted
- 1The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- 2General Hospital of Eastern Theatre Command Department of Radiation Oncology, Nanjing, China
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Purpose: The study aimed at investigating the optimal timing strategy of tourniquet use in primary total knee arthroplasty (TKA). Methods: A systematic search of PubMed, EMBASE, Web of Science, and the China National Knowledge Infrastructure (CNKI) was conducted for randomized controlled trials (RCTs) published up to January 2023. The included studies compared the use of a tourniquet solely during cementation (SDT) versus its use for the majority of the surgical procedure (MDT). The MDT was defined as tourniquet inflation prior to the surgical incision and deflation only after cement hardening. Continuous variables were pooled by using weighted mean difference (WMD), and relevant subgroups were analyzed independently. Results: Six studies involving 358 patients with 386 knees were included, which were assigned to the SDT group and the MDT group. The meta-analysis showed that the SDT group could increase intraoperative blood loss (WMD=−68.62, 95% CI: [−93.72, −43.52], P<0.001), but did not increase the total blood loss (P=0.82). The SDT group would not increase the operation time (P=0.16), but would improve the postoperative knee VAS score (WMD= 0.77, 95%CI:[0.31, 1.23], P= 0.001),and the knee range of motion (ROM) on 3 days postoperatively (WMD=−6.69, 95%CI:[−9.29, −4.08], P< 0.00001).Meanwhile, No significant difference in ROM was observed between the groups at 2 weeks postoperatively (P=0.31). Finally, The SDT group decreased the risk of postoperative complications risk ratio (RR) (2.77; 95% CI: [1.04, 7.43]; P=0.04). Conclusion: SDT strategy may be associated with a reduced risk of postoperative complications and accelerated early functional recovery compared to MDT strategy undergoing primary TKA. Therefore, Tourniquet application in SDT is the optimal timing during primary TKA.
Keywords: Cementation, duration, Surgery, TKA, Tourniquet
Received: 01 Nov 2025; Accepted: 09 Feb 2026.
Copyright: © 2026 Shen, Wang and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xu Shen
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