Endothelin-1 is secreted after total knee arthroplasty regardless of the use of a tourniquet.
Early infections and wound healing disorders after implantation of a total knee replacement occur regardless of the intraoperative use of a tourniquet. The biochemical regulatory processes responsible for the disturbances in microcirculation and thus the potential therapeutic options have yet to be elucidated. The hypothesis of the present paper was that endothelin-1 (ET-1), a mediator of microcirculation disturbances in parenchymatous organs, also is released after major operations on peripheral joints. The concentration of ET-1 in the plasma was determined preoperatively and at 10 postoperative time points (5 min-48 h) with (group A, n=10) and without the use of a tourniquet (group B, n=10). The ET-1 concentration achieved its maximum 6h after opening the tourniquet, which corresponded to 3.3 times the preoperative value. Without a tourniquet, the concentration maximum (2.9 times the baseline value) was achieved already 1.5 h after the end of the operation. However, the total amount of ET-1 secreted over 24 h was identical in both groups (p>0.5). We conclude that the tissue hypoxia resulting from the use of a tourniquet modulates ET-1 secretion, but that traumatization during the operation has a much stronger influence on the total amount secreted. ET-1 antagonists thus should be discussed for the drug prophylaxis of wound healing disorders, regardless of the use of a tourniquet.
Matziolis
G
G
Center for Musculoskeletal Surgery, Charité University Hospital, Schumannstr. 20-21, 10117 Berlin, Germany. georg.matziolis@charite.de
Drahn
T
T
Schröder
J H
JH
Krocker
D
D
Tuischer
J
J
Perka
C
C
D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D019332:Endothelin-1 / Q000097:blood / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014111:Tourniquets; D014945:Wound Healing
D019332:Endothelin-1