The authors declare that they have no competing interests.
AE: study design, data collection, statistics, analysis and writing. PTN: study design, analysis and writing. TJ: study design, analysis and writing. ACL: data collection, analysis and writing. AK: data collection and writing. SR: study design, analysis and writing Critical revision of the manuscript was performed by all authors. All authors read and approved the final manuscript.
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).
Seventy 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.
Significant 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.
Microdialysis revealed that performing TKA with tourniquet is associated with increased ischemia. This affects all metabolites but the changes are normalized after 5 h
Heppenstall RB, Scott R, Sapega A, Park YS, Chance B. A comparative study of the tolerance of skeletal muscle to ischemia. Tourniquet application compared with acute compartment syndrome. J Bone Joint Surg Am. 1986;68:820–8. PubMed
Abdel-Salam A, Eyres KS. Effects of tourniquet during total knee arthroplasty. A prospective randomised study. J Bone Joint Surg (Br). 1995;77:250–3.
Wakankar HM, Nicholl JE, Koka R, D’Arcy JC. The tourniquet in total knee arthroplasty. A prospective, randomised study. J Bone Joint Surg (Br). 1999;81:30–3. CrossRef
Korth U, Merkel G, Fernandez FF, Jandewerth O, Dogan G, Koch T, et al. Tourniquet-induced changes of energy metabolism in human skeletal muscle monitored by microdialysis. Anesthesiology. 2000;93:407–12. CrossRef
Ungerstedt U, Pycock C. Functional correlates of dopamine neurotransmission. Bull Schweiz Akad Med Wiss. 1974;30:44–55. PubMed
Rosdahl H, Hamrin K, Ungerstedt U, Henriksson J. Metabolite levels in human skeletal muscle and adipose tissue studied with microdialysis at low perfusion flow. Am J Physiol. 1998;274:936–45.
Hagström-Toft E, Enoksson S, Moberg E, Bolinder J, Arner P. Absolute concentrations of glycerol and lactate in human skeletal muscle, adipose tissue, and blood. Am J Physiol. 1997;273:584–92.
- Tourniquet induced ischemia and changes in metabolism during TKA: a randomized study using microdialysis
Anders C. Laursen
Poul Torben Nielsen
- BioMed Central
Neu im Fachgebiet Orthopädie und Unfallchirurgie
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