{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:46:11Z","timestamp":1787755571662,"version":"build-2784847793"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,5,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Total knee arthroplasty (TKA) is one of the most commonly performed elective procedures in North America. While advancements have been made in patient optimization, surgical technique, and implant design, tourniquet use remains a contentious issue as it relates to patient outcomes and postoperative experience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>As part of the PEPPER trial, we identified 5,684 patients who underwent primary TKA, of whom 4,866 (85.6%) underwent surgery with a tourniquet (the YT group) and 818 (14.4%) underwent surgery without a tourniquet (the NT group). The cohort was predominantly female (60.8%), White (77%), and of an ethnicity other than Hispanic or Latino (96.8%). The mean age of the patients was 64.6 \u00b1 9.2 years. The primary outcomes were the Knee injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS JR); Patient-Reported Outcomes Measurement Information System Physical Health Summary (PROMIS-PH10); and numeric pain rating scale (NPRS), which were captured preoperatively and at 1, 3, and 6 months postoperatively. The secondary outcomes were length of stay, discharge disposition, analgesic consumption, and postoperative complications. Multivariable analysis was performed to assess the associations between tourniquet use and patient-reported outcome measures (PROMs) following TKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The percentages of patients achieving the minimal clinically important difference (MCID) for the KOOS JR were significantly different at 1 month only (YT, 55.4%; NT, 47.9%). This difference disappeared at 3 and 6 months. There was no difference between the YT and NT groups in terms of the percentage of patients achieving the MCID for the PROMIS-PH10 or NPRS at any time point. There were no differences between the YT and NT groups at any time point with respect to the KOOS JR, PROMIS-PH10, and NPRS. There were no differences in opioid consumption, operative time, length of stay, wound-related complications, or readmissions postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Tourniquet use was associated with more patients achieving the MCID for the KOOS JR at 1 month compared with no tourniquet use. This difference disappeared at 3 and 6 months. At 1, 3, and 6 months, there were no differences in opioid consumption, health-care utilization, or complications between patients undergoing TKA with a tourniquet versus without a tourniquet. Tourniquet use did not have a clinically meaningful impact on PROMs in the multivariable analysis. Arthroplasty surgeons may use these data during preoperative discussions with patients regarding tourniquet use as it relates to the surgeon\u2019s preference and how it could influence postoperative function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.24.00266","type":"journal-article","created":{"date-parts":[[2025,3,20]],"date-time":"2025-03-20T17:54:56Z","timestamp":1742493296000},"page":"976-984","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Association Between Tourniquet Use and Patient-Reported Outcomes Following Total Knee Arthroplasty"],"prefix":"10.2106","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3656-5850","authenticated-orcid":false,"given":"Brian","family":"Gibbs","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2482-5093","authenticated-orcid":false,"given":"Jhase","family":"Sniderman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Massachusetts"},{"name":"Department of Orthopaedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3107-2969","authenticated-orcid":false,"given":"Shariq","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Boston University, Boston, Massachusetts"},{"name":"Rafik B. Hariri Institute for Computing and Computational Science and Engineering, Boston University, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5615-8945","authenticated-orcid":false,"given":"Michael","family":"Kain","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2444-7099","authenticated-orcid":false,"given":"David","family":"Freccero","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7180-8259","authenticated-orcid":false,"given":"Ayesha","family":"Abdeen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of The PEPPER Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,3,20]]},"reference":[{"issue":"17","key":"bib1-20250509","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.2106\/JBJS.17.01617","article-title":"Projected Volume of Primary Total Joint Arthroplasty in the U.S., 2014 to 2030","volume":"100","author":"Sloan","year":"2018","journal-title":"J Bone Joint Surg Am."},{"issue":"1","key":"bib2-20250509","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1007\/s11999-009-1119-9","article-title":"Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?","volume":"468","author":"Bourne","year":"2010","journal-title":"Clin Orthop Relat Res."},{"issue":"1","key":"bib3-20250509","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1186\/s12891-018-2340-z","article-title":"Revisiting patient satisfaction following total knee arthroplasty: a longitudinal observational study","volume":"19","author":"Bryan","year":"2018","journal-title":"BMC Musculoskelet Disord."},{"issue":"8","key":"bib4-20250509","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1055\/s-0039-1681035","article-title":"Tourniquet Use in Total Knee Arthroplasty","volume":"32","author":"Arthur","year":"2019","journal-title":"J Knee Surg."},{"issue":"6","key":"bib6-20250509","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1007\/s00590-013-1278-y","article-title":"The effect of tourniquet use in total knee arthroplasty: grading the evidence through an updated meta-analysis of randomized, controlled trials","volume":"24","author":"Li","year":"2014","journal-title":"Eur J Orthop Surg Traumatol."},{"issue":"6","key":"bib8-20250509","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1302\/2046-3758.96.BJR-2019-0180.R3","article-title":"The effect of tourniquet uses on total blood loss, early function, and pain after primary total knee arthroplasty: a prospective, randomized controlled trial","volume":"9","author":"Zhao","year":"2020","journal-title":"Bone Joint Res."},{"issue":"5","key":"bib9-20250509","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1302\/0301-620X.103B.BJJ-2020-1926.R1","article-title":"Time to reconsider the routine use of tourniquets in total knee arthroplasty surgery","volume":"103-b","author":"Ahmed","year":"2021","journal-title":"Bone Joint J."},{"issue":"24","key":"bib10-20250509","doi-asserted-by":"crossref","first-page":"2053","DOI":"10.2106\/JBJS.16.01525","article-title":"Intravenous and Topical Tranexamic Acid Alone Are Superior to Tourniquet Use for Primary Total Knee Arthroplasty: A Prospective, Randomized Controlled Trial","volume":"99","author":"Huang","year":"2017","journal-title":"J Bone Joint Surg Am."},{"issue":"7","key":"bib11-20250509","doi-asserted-by":"crossref","first-page":"S233","DOI":"10.1016\/j.arth.2022.12.034","article-title":"Trends in Total Knee Arthroplasty Cementing Technique Among Arthroplasty Surgeons-A Survey of the American Association of Hip and Knee Surgeons Members","volume":"38","author":"Martin","year":"2023","journal-title":"J Arthroplasty."},{"issue":"6","key":"bib12-20250509","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1016\/j.arth.2022.12.035","article-title":"The Fragility of Tourniquet Use in Total Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials","volume":"38","author":"Cordero","year":"2023","journal-title":"J Arthroplasty."},{"issue":"3","key":"bib13-20250509","doi-asserted-by":"crossref","first-page":"e060000","DOI":"10.1136\/bmjopen-2021-060000","article-title":"Steering Committee of the PEPPER Trial and the PEPPER Trial Investigators, funded by PCORI. 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