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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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Does Robotic Assisted Unicompartmental Knee Arthroplasty Restore Native Jointline More Accurately Than With Conventional Instruments? ePoster Presentation Ashok Kumar Podhili Subramani, MS, INDIA Shantanu S. Patil, MBBS, MS(Orth), INDIA SAWAN PAWAR, MBBS MS (ORTH), INDIA Kalaivanan Kanniyan, MBBS MS Orth, INDIA karthik jayachandran, MS, INDIA PICHAI SURYANARAYAN, MBBS MS ORTH, INDIA
Implant Size and Outcome Differences of Knees in Same Patient for Simultaneous vs Staged Bilateral TKA ePoster Presentation Alexander P. Sah, MD, UNITED STATES
Clinical Comparison and Survival Rate Between Unicompartmental Knee Arthroplasty and High Tibial Osteotomy With An External Fixator For Varus Knee In Patients Younger Than 60 Years at Mid-Term Follow-Up ePoster Presentation Amit Kumar Yadav, M.S (Orth),DNB(Orth),MNAMS, UNITED KINGDOM Riccardo D'Ambrosi, MD, ITALY Mangal Parihar, MS Ortho, INDIA
The Functional Outcome of Zimmer Biomet’s Nexgen Total Knee Arthroplasty as Compared with Healthy Older Adults ePoster Presentation Gwenllian F. Tawy, PhD, MRes, BSc(Hons), UNITED KINGDOM Michael J. McNicholas, BSc, MD, FRCS Tr & Orth, UNITED KINGDOM Leela C. Biant, MS, MFSTEd, FRCSEd(Tr&Orth), UNITED KINGDOM
Antibiotic-Loaded Bone Cement with Colistin at Erythromycin Do Not Decrease Chronic TKA Pji at a Long-Term ePoster Presentation Daniel Pérez-Prieto, MD, SPAIN Albert Fontanellas, MD, SPAIN Pedro Hinarejos, MD, PhD, SPAIN Juan Francisco Sanchez-Soler, MD, PhD, SPAIN Raúl Torres-Claramunt, PhD, SPAIN Joan Carles Monllau, MD, PhD, Prof., SPAIN
Novel Technique For Surgeon-Placed Nerve Block And Continuous Nerve Block In Total Knee Arthroplasty. A Cadaveric Study ePoster Presentation Daniel E Matthews, MD, FAAOS, UNITED STATES
Differences In Pain, Sleep Status And Functional Recovery Between TKA And UKA ePoster Presentation Takeo Mammoto, MD, JAPAN
Calipered Measurements Method For Kinematically Aligned Total Knee Arthroplasty Has A Risk Of Excessive Varus Cut For The Proximal Tibia In Japanese Varus Knees ePoster Presentation Umit Kuwa, MD, PhD, JAPAN Masafumi Itoh, MD, PhD, JAPAN Junya Itou, MD, PhD, JAPAN Ken Okazaki, MD, PhD, JAPAN
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, PhD, JAPAN Tomofumi Kage, JAPAN Ryo Murakami, MD, JAPAN Hiroshi Inui, PhD, JAPAN Sakae Tanaka, MD, PhD, JAPAN
Same Complication Rate After Day-Case Procedure Or Fast-Track Procedure After Total Hip And Knee Arthroplasty. A Prospective, Propensity Score-Matched Case-Control Study ePoster Presentation Jean-Yves Jenny, Prof., FRANCE Vincent Gisonni, MD, FRANCE
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
Time-Driven Activity-Based Costs for Manipulation Under Anesthesia after Total Knee Arthroplasty ePoster Presentation Gloria Shoshana Coden, MD, UNITED STATES Suzanne Kent, MD, UNITED STATES John Mazzocco, MD, UNITED STATES Lauren Schoeller, BS, UNITED STATES Ruijia Niu, MPH, UNITED STATES Daniel C Sun, UNITED STATES Eric L. Smith, MD, UNITED STATES

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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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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