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The Statistical Fragility of Tourniquet Use In Total Knee Arthroplasty: A Systematic Review

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The Statistical Fragility of Tourniquet Use In Total Knee Arthroplasty: A Systematic Review

Kyle William Lawrence, BS, UNITED STATES John K Cordero, MD, UNITED STATES Ashley Brown, BS, UNITED STATES Xinning Li, MD, UNITED STATES Brett Hayden, MD, UNITED STATES Robert L Parisien, MD, UNITED STATES

Icahn School of Medicine at Mount Sinai, New York, New York, UNITED STATES

2023 Congress ePoster Presentation 2023 Congress Not yet rated

Anatomic Location

Knee

Anatomic Structure

Bones

Diagnosis / Condition

Osteoarthritis

Treatment / Technique

Arthroplasty

Sports Medicine

Evidence Based Medicine Outcome Studies Research

Summary: Statistical fragility exists in RCTs on tourniquet use in TKA, especially for statistically significant results. Altering a small number of outcomes is sufficient to reverse study findings. Reporting FI and FQ values may provide a more reliable representation of study conclusions in RCTs in TKA.

Background

Fragility index (FI) and reverse fragility index (reverse FI) are informative metrics for evaluating the robustness of clinical trial data, representing the number of outcome event reversals necessary to change the significance of a study.

Methods

We queried PubMed/EMBASE/MEDLINE for randomized controlled trials (RCTs) comparing outcomes in total knee arthroplasty (TKA) where study groups were stratified by tourniquet-use strategy. FI and reverse FI were determined – for significant and non-significant outcomes, respectively – by determining the number of outcome reversals required to change statistical significance. The fragility quotient (FQ) was calculated by dividing the FI or reverse FI by the sample size. Subgroup analysis was performed by outcome type.

Results

Literature search yielded 23 studies from 18 orthopaedic journals reporting a total of 91 dichotomous outcomes. The median FI of the 91 outcome events was 4 (IQR 3-6) with an FQ of 0.0476 (IQR 0.0291-0.0867). 11 outcomes were reported as statistically significant with a median FI of 2 (IQR 1.5-5) and a median FQ of 0.0200 (IQR 0.0148-0.0484). 80 outcomes were reported as non-significant with a median reverse FI of 4 (IQR 3-6) and a median FQ of 0.0495 (IQR 0.0310-0.0887). Outcomes were categorized into skin/wound complications, transfusion requirement, deep vein thrombosis, postoperative pain, and re-intervention, with FIs of 4 (IQR 3-6), 3 (IQR 2-5), 4 (IQR 4-6), 5.5 (IQR 5-7.5), and 3 (IQR 3-4.5), respectively. Total patients lost to follow-up was greater than the median FI in 17.6% of outcomes.

Conclusions

Statistical fragility exists in RCTs on tourniquet use in TKA, especially for statistically significant results. Altering a small number of outcomes is sufficient to reverse study findings. Reporting FI and FQ values may provide a more reliable representation of study conclusions in RCTs on tourniquet use in TKA.

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Changes In CPAK Classification and Its Characteristics before and after Kinematic Alignment TKA ePoster Presentation Manabu Akagawa, MD, PhD, JAPAN ヒデトモサイトウ, MD, PhD, JAPAN Naohisa Miyakoshi, MD, PhD, JAPAN
Quality of Life Following Primary Total Knee Arthroplasty: Factors Predicting Satisfaction in Low-Income Population ePoster Presentation Mohamed Amine Gharbi , MD, TUNISIA Houssem Eddine Chahed, MD, TUNISIA Ahmed Zendeoui, MD, TUNISIA Moatassem Belleh Jelassi, MD, TUNISIA Anis Tebourbi, MD, TUNISIA Ramzi Bouzidi, PhD, TUNISIA Khelil Ezzaouia, PhD, TUNISIA Mouadh Nefiss, MD, TUNISIA
Comparative Analysis Of Time Taken In Conventional vs. Robotic Assisted Total Knee Arthroplast ePoster Presentation Sanjay B. Londhe, MS, FRCS, FRCSI, MCh, INDIA Santosh Chandrashekar Shetty, MS, INDIA Ashit Hasmukhbhai Shah, FRCS Orth, M ChOrth, M S Orth, D N B Orth, INDIA Niraj Vora, MS,MRCS, INDIA Vijay Shetty, MD, MSc, FRCSC, INDIA Rakesh Nair, MS, INDIA Clevio Joao Baptista Desouza, MS , INDIA Farheen Khan, B.Tech, INDIA
Effect of Direct Adductor Canal Block Performed by a Surgeon in a Patient Who Underwent Simultaneous Bilateral TKA ePoster Presentation Man-Soo Kim, MD, PhD, KOREA, REPUBLIC OF Dongho Kwak, MD, KOREA, REPUBLIC OF Sungcheol Yang, MD, KOREA, REPUBLIC OF Hyukjin Jang, MD, KOREA, REPUBLIC OF Ryu Kyoung Cho, MD, KOREA, REPUBLIC OF Yong In, MD, PhD, KOREA, REPUBLIC OF
Combined Fixed-Bearing Unicompartmental Knee Arthroplasty and Anterior Cruciate Ligament Reconstruction ePoster Presentation Claudio Legnani, MD, ITALY Enrico Borgo, MD, ITALY Vittorio Macchi, MD, ITALY Alberto Ventura, MD, ITALY
Preoperative Bone Marrow Edema Negatively Impacts Intermediate to Long-Term Outcomes after Unicompartmental Knee Arthroplasty ePoster Presentation Hong Yeol Yang, MD, PhD, KOREA, REPUBLIC OF Jong-Keun Seon, MD, PhD, Prof, KOREA, REPUBLIC OF
Participation of Physical Activity Following Knee Arthroplasty: A Meta-Analysis ePoster Presentation Ahmed A Magan, BM BSc (Hons) MRCS (Eng) FRCS (Eng) Trauma & Orth, UNITED KINGDOM Babar Kayani, BSc (HONS), MBBS, MRCS (Eng), UNITED KINGDOM Warran Wignadasan, MBBS, BSc (Hons), MRCS, UNITED KINGDOM Dia Eldean Giebaly, MBChB, MSc, FRCS, EMBA, UNITED KINGDOM Flaminia Ronca, PHD, UNITED KINGDOM Fares S. Haddad, MCh(Orth), BSc, FRCS(Orth), UNITED KINGDOM
Is Surgeon Assessed Bone Quality During Total Knee Arthroplasty a Valid Tool To Diagnose Osteoporosis ? ePoster Presentation Adit Maniar, MBBS, MS Orthopaedics, DNB Orthopaedics, CANADA Arpit Vasantbhai Bavaskar, MBBS, D.Orth., INDIA Vishal Raina, MS, INDIA Akshay Nayak, M.B.B.S, M.S , INDIA Ashwini Khokhar, MS, INDIA Rajesh Maniar, INDIA
A Prospective Randomised Study to Compare the Clinical and Radiological Outcomes of Functionally Aligned versus Mechanically Aligned Total Knee Arthroplasty with Robotic Arm Assistance ePoster Presentation Jai Thilak, MS, MCh, FRCS, INDIA Amal Antony Paul, MBBS, INDIA
Comparison of Outcomes between Fungal and Non-fungal Periprosthetic Joint Infections in Total Knee Arthroplasty: A Propensity Score-Matched Analysis ePoster Presentation Hong Yeol Yang, MD, PhD, KOREA, REPUBLIC OF Jong-Keun Seon, MD, PhD, Prof, KOREA, REPUBLIC OF
Antero-Posterior Translation of Mobile-Bearing in Mobile-Bearing Unicompartmental Knee Arthroplasty ePoster Presentation Takahiro Arakawa, MD, JAPAN Kenichi Kono, MD, PhD, JAPAN Tetsuya TOMITA, MD, PhD, JAPAN Shuji Taketomi, MD, PhD, JAPAN Ryota Yamagami, MD, JAPAN Kohei Kawaguchi, MD, JAPAN Tomofumi Kage, JAPAN Ryo Murakami, MD, JAPAN Hiroshi Inui, PhD, JAPAN Sakae Tanaka, MD, PhD, JAPAN

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The Statistical Fragility of Tourniquet Use In Total Knee Arthroplasty: A Systematic Review

The Statistical Fragility of Tourniquet Use In Total Knee Arthroplasty: A Systematic Review

Background

Methods

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Conclusions

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The Statistical Fragility of Tourniquet Use In Total Knee Arthroplasty: A Systematic Review

The Statistical Fragility of Tourniquet Use In Total Knee Arthroplasty: A Systematic Review

Background

Methods

Results

Conclusions

More 2023 ISAKOS Congress Content