Releasing of Tourniquet Before Wound Closure or not in Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

The purpose of this study is to examine our hypothesis that releasing tourniquet intraoperatively before wound closure is better than releasing postoperatively after wound closure and bandaging. We carried out a systematic review using meta-analysis of selected randomized controlled trials comparing tourniquet releasing before and after wound closure in TKA. The results showed that tourniquet releasing before wound closure significantly increased the total blood loss (P < 0.00001), calculated blood loss (P < 0.0001) as well as postoperative blood loss (P = 0.007). However, it decreased the risk of both minor (P = 0.0007) and major complications (P = 0.05). The available evidence indicated that releasing tourniquet before wound closure for hemostasis increased perioperative blood loss, nevertheless, the risk of complications decreased significantly.