PT - JOURNAL ARTICLE AU - Muhamed M Farhan-Alanie AU - Yujin Lee AU - Martin Underwood AU - Andrew Metcalfe AU - Mark J Wilkinson AU - Andrew James Price AU - Jane Warwick AU - Peter David Henry Wall TI - Effect of tourniquet use on the risk of revision in total knee replacement surgery: an analysis of the National Joint Registry Data Set AID - 10.1136/bmjopen-2020-045353 DP - 2021 Jun 01 TA - BMJ Open PG - e045353 VI - 11 IP - 6 4099 - http://bmjopen.bmj.com/content/11/6/e045353.short 4100 - http://bmjopen.bmj.com/content/11/6/e045353.full SO - BMJ Open2021 Jun 01; 11 AB - Objective Tourniquet use in total knee replacement (TKR) is believed to improve the bone-cement interface by reducing bleeding, potentially prolonging implant survival. This study aimed to compare the risk of revision for primary cemented TKR performed with or without a tourniquet.Design We analysed data from the National Joint Registry (NJR) for all primary cemented TKRs performed in England and Wales between April 2003 and December 2003. Kaplan-Meier plots and Cox regression were used to assess the influence of tourniquet use, age at time of surgery, sex and American Society of Anaesthesiologists (ASA) classification on risk of revision for all-causes.Results Data were available for 16 974 cases of primary cemented TKR, of which 16 132 had surgery with a tourniquet and 842 had surgery without a tourniquet. At 10 years, 3.8% had undergone revision (95% CI 2.6% to 5.5%) in the no-tourniquet group and 3.1% in the tourniquet group (95% CI 2.8% to 3.4%). After adjusting for age at primary surgery, gender and primary ASA score, the HR for all-cause revision for cemented TKR without a tourniquet was 0.82 (95% CI 0.57 to 1.18).Conclusions We did not find evidence that using a tourniquet for primary cemented TKR offers a clinically important or statistically significant reduction in the risk of all-cause revision up to 13 years after surgery. Surgeons should consider this evidence when deciding whether to use a tourniquet for cemented TKR.Access to the data analysed in this study required permission from the National Joint Registry for England, Wales and Northern Ireland Research Sub-committee. http://www.njrcentre.org.uk/njrcentre/Research/Researchrequests/tabid/305/Default.aspx contains information on research data access request to the National Joint Registry.