The relationship between tourniquet duration and Il-6, d-dimer and visual analogue scale in Total knee arthroplasty

Abstract

Introduction: Total knee arthroplasty (TKA) is commonly done with tourniquet device placed around the thigh. The use of tourniquet during TKA, aside, from having several advantages, is also accompanied by several risks. Some of these complications are increasing pain due to tourniquet inflation, reperfusion syndrome that leads to the increase of several pro inflammatory cytokines, such as IL-6, as well as increasing D-dimer as a marker for thromboembolic events. Methods: This study is a cross-sectional analytical experimental research performed in patients with primary osteoarthritis of the knee who failed conservative treatment and agreed to undergo Total Knee Arthroplasty. Blood samples were taken from the patients and IL-6 cytokine and D-dimer levels were identified using ELISA method. Visual Analogue Scale (VAS) was assessed at 12 hours and 24 hours post operation. Results: The result of this study showed a positive correlation between the length of tourniquet used with IL-6 at 12 hours post operation (r=0.359) and 24 hours post operation (r=0.658); with D-dimer at 12 hours post operation (r=0.491) and 24 hours post operation (r=0.483); and with VAS at 12 hours post operation (r=0.647) and 24 hours post operation (r=0.507) with p < 0,05. Conclusion: A positive correlation was found between tourniquet time and the level of IL-6 and D-dimer, and VAS. The duration of tourniquet cut-off time of more than 122.5 minutes elevated IL-6 and D-Dimer levels which increased the risk for SIRS and DVT