The Use of Cement and Tourniquet During Total Knee Arthroplasty Does Not Increase the Risk of Venous Thromboembolism Postoperatively

Abstract

Background: Venous thromboembolism (VTE) is a severe complication of total knee arthroplasty (TKA). Cementation and the use of tourniquet during TKA have both been hypothesized to be risk factors of VTE. The purpose of our study was to determine if either of these surgical factors increases the risk of VTE in patients undergoing TKA. Methods: A single-institution, retrospective study was conducted, consisting of 16,972 patients undergoing a primary or revision TKA from 2008 to 2020. Of the total, 1020 patients were excluded from the tourniquet analysis as tourniquet data were unavailable. Clinical records were consulted to identify demographics, surgical variables, and outcomes. Queries of clinical notes and phone-call logs were conducted to capture VTE events following discharge. Statistical analysis consisted of univariate analysis, regression analysis, and propensity score matching. Results: Compared to patients who did not receive tourniquet, the patients with tourniquet did not demonstrate a significantly higher rate of VTE in the univariate analysis (1.00 vs 1.31, P = .132). Propensity score analysis also showed no difference between the 2 cohorts (1.10 vs 0.85, P = .306). Cemented patients similarly did not demonstrate an increased risk of VTE in either the univariate (1.26 vs 1.22, P = .895) or propensity score analysis (1.42 vs 1.26, P = .710) compared to cementless patients. Regression analysis, looking at the interaction between cement and tourniquet with VTE risk as the dependent variable, revealed neither to be risk factors for VTE (odds ratio 1.38, 95% confidence interval 0.63-3.08, P = .426). Conclusions: In our cohort, neither tourniquet nor cement was a significant risk factor for VTE following TKA.

Keywords

• Knee
• Arthroplasty
• Cement
• Tourniquet
• VTE