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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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Bicruciate Substituting Total Knee Arthroplasty Improved Anteroposterior Displacement in Mid-Flexion Range ePoster Presentation Keinosuke Ryu, Prof., JAPAN Takanori Iriuchisima, MD, JAPAN
Lateral Unicompartmental Knee Arthroplasty (UKA) Showed a Lower Risk of Failure Compared to Medial Unicompartmental Knee Arthroplasty in the Register of Prosthetic Orthopedic Implants (RIPO) ePoster Presentation Stefano Zaffagnini, MD, Prof., ITALY Domenico Alesi, MD, ITALY Barbara Bordini, Stat, ITALY Stefano Fratini, MD, ITALY Cristina Ancarani, Stat, ITALY Piero Agostinone, MD, ITALY Alberto Grassi, PhD, ITALY Giulio Maria Marcheggiani Muccioli, MD, PhD, Associate Professor, ITALY
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, MD, INDIA Farheen Khan, B.Tech, INDIA
Effect of Altered Knee Joint Loading Pattern in Gait Biomechanics of Total Knee Arthroplasty Patient ePoster Presentation Sang Jin Lee, MD, PhD, KOREA, REPUBLIC OF
Modular Knee Arthrodesis as Definitive Treatment for Periprosthetic Infection, Bone Loss, and Failure of the Extensor Mechanism after Total Knee Arthroplasty ePoster Presentation Gloria Shoshana Coden, MD, UNITED STATES Maksym Bartashevskyy, BA, UNITED STATES Zachary Berliner, MD, UNITED STATES Ruijia Niu, MPH, UNITED STATES James V. Bono, MD, UNITED STATES Ayesha Abdeen, MD, UNITED STATES Eric L. Smith, MD, UNITED STATES
Golfers Have Greater Preoperative and Equal Postoperative Function When Undergoing Total Knee Arthroplasty Compared to Non-Golfers ePoster Presentation Patrick G Robinson, MBChB, MRCS, MS, MBA, UNITED KINGDOM Robert Kay, MBChB, UNITED KINGDOM Deborah Macdonald, BA(Hons), UNITED KINGDOM Andrew Murray, MBChB, FFSEM, UNITED KINGDOM Nick David Clement, MBBS, MD, PhD, FRCS(Orth), UNITED KINGDOM
In-Vivo Kinematic Analysis of Evolution® Medial-Pivot Total Knee Arthroplasty during Weight-Bearing Activity ePoster Presentation Eiichi Nakamura, MD, PhD, JAPAN Nobukazu Okamoto, MD, PhD, JAPAN Hitoshi Ito, MD, PhD, JAPAN Tetsurou Masuda, MD, PhD, JAPAN Satoshi Hisanaga, MD, PhD, JAPAN Yasunari Oniki, MD, PhD, JAPAN
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 Kailathuvalapil, MS, MCh, FRCS, INDIA Amal Antony Paul, MBBS, INDIA
Use of Tibial Stem for Patients with Morbid Obesity in Total Knee Arthroplasty ePoster Presentation José Eduardo Flores Naranjo, MD, MEXICO Adrian Aziz Cortes De La Fuente, MD, MEXICO Octavio Martinez Montiel, MD, MEXICO Fernando Martinez Zuñiga, MD, MEXICO
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
Success of Debridement, Antibiotics, and Implant Retention vs Revision In Early And Late Prosthetic Joint Infections Following Primary TKA: A Prospective, Multicenter Study of 251 Cases ePoster Presentation Mark Zhu, MBChB, NEW ZEALAND Richard Rahardja, MBChB, BMedSc(Hons), NEW ZEALAND Laurens Manning, MBChB, AUSTRALIA Sarah Metcalf, MBChB, NEW ZEALAND Simon W. Young, MD, FRACS, NEW ZEALAND

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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

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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