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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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Incidence and Prevention of Deep Vein Thrombosis Using Thromboprophylaxis in Total Knee Replacement: A Prospective Clinical Study ePoster Presentation Amit Lakhani, MS, DNB, MRCPS(Glassg), MNAS, INDIA
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
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
Patient Satisfaction and Functional outcomes in a Latin American cohort: Comparative Study Between Conventional Technique vs. Robotic Arm Assistance. ePoster Presentation Rafael Calvo, MD, CHILE Maria Loreto Figueroa Berrios, MD, CHILE Rodrigo Guiloff, MD, Prof, CHILE Zoy Anastasiadis, MD, CHILE David H. Figueroa, MD, CHILE
Anatomical distribution of radiological OA Influences the Outcome of TKA ePoster Presentation Johanna Elliott, MB, BS, B.Med Sci, Master Science, GERMANY
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
Association Between The Femoral And Tibial Component Positions and Intraoperative Knee Kinematics In Posterior-Stabilized Total Knee Arthroplasty ePoster Presentation Mitsuru Hanada, MD, PhD, JAPAN Yukihiro Matsuyama, MD, PhD, Prof., JAPAN
Subtalar Joint Compensation using Full-length Standing Lower Extremity Anteroposterior Radiograph after Total Knee Arthroplasty for Varus Osteoarthritis in Nara Medical University Hospital with 2-year Follow-up ePoster Presentation Jerre Co De Guzman, MD, PHILIPPINES Munehiro Ogawa, MD, PhD, JAPAN Yusuke Ozaki, MD, JAPAN Yasuhito Tanaka, Prof., JAPAN Yuki Nishimura, MD, JAPAN Maria Elizabeth Mercado, MD, MAS, PHILIPPINES
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
Phenotypic Differences In Coronal Alignment In Robot-Assisted Total Knee Arthroplasty Do Not Affect Patient-Reported Outcome Measurements In A Three-Dimensional Computed Tomography Analysis: A Single-Center Cohort Study ePoster Presentation Takao Kaneko, MD, PhD,, JAPAN Ayakane Yamamoto, MD, JAPAN Kazutaka Takada, MD, JAPAN Shu Yoshizawa, MD, JAPAN Hiroyasu Ikegami, MD, PhD, Prof., 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
Advanced Active Robotic Technology for Total Knee Arthroplasty: A Learning Curve of Operative Time and Alignment Accuracy ePoster Presentation Yong-Beom Park, MD, PhD, KOREA, REPUBLIC OF Young-Bong Ko, MD, KOREA, REPUBLIC OF Dong-Hoon Lee, MD, KOREA, REPUBLIC OF Hyun-Chul Nam, MD, KOREA, REPUBLIC OF Seong-Hwan Kim, MD,Ph.D, MStat, KOREA, REPUBLIC OF
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

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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