Abstract
BackgroundTourniquet use in total knee arthroplasty (TKA) surgery is applied to minimize blood loss thereby creating better overview of the surgical field. This induces ischemia in the skeletal muscle resulting in reperfusion injury. Our aim was to investigate the in vivo metabolic changes in the skeletal muscle during TKA surgery using microdialysis (MD).MethodsSeventy patients were randomly allocated to tourniquet group (n = 35) or non-tourniquet group (n = 35). Prior to surgery, catheters were inserted in the operated leg and non-operated leg. Interstitial dialysate was collected before and after surgery and at 20 min intervals during a 5 h reperfusion period. Main variables were ischemic metabolites: glucose, pyruvate, lactate and glycerol and L/P ratio.ResultsSignificant difference in all metabolites was detected between the two groups, caused by tourniquet application. Tourniquet induced ischemia resulted in decreased levels of glucose and pyruvate to 54 and 60 % respectively, compared to baseline. Simultaneously, accumulation of lactate to 116 % and glycerol to 190 % was observed. L/P ratio was elevated indicating ischemia.In the non-tourniquet group the metabolite changes were less profound and normalized within 60 min.ConclusionsMicrodialysis revealed that performing TKA with tourniquet is associated with increased ischemia. This affects all metabolites but the changes are normalized after 5 h
Highlights
Tourniquet use in total knee arthroplasty (TKA) surgery is applied to minimize blood loss thereby creating better overview of the surgical field
The skeletal muscle in limbs is very sensitive to ischemic changes and a clinical assessment is not sufficient to evaluate the degree of ischemic tissue damage induced by the tourniquet [7, 8]
The ischemic conditions of tourniquet use are presented in this publication
Summary
Tourniquet use in total knee arthroplasty (TKA) surgery is applied to minimize blood loss thereby creating better overview of the surgical field. This induces ischemia in the skeletal muscle resulting in reperfusion injury. Our aim was to investigate the in vivo metabolic changes in the skeletal muscle during TKA surgery using microdialysis (MD). In elective TKA the intraoperative use of pneumatic tourniquet is commonly used to minimize blood loss and enhance surgical overview. The skeletal muscle in limbs is very sensitive to ischemic changes and a clinical assessment is not sufficient to evaluate the degree of ischemic tissue damage induced by the tourniquet [7, 8]. Using an in vivo technique could provide a more accurate assessment of the metabolic events
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