Tourniquet induced ischemia and changes in metabolism during TKA: a randomized study using microdialysis.
BACKGROUND
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).


METHODS
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.


RESULTS
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.


CONCLUSIONS
Microdialysis revealed that performing TKA with tourniquet is associated with increased ischemia. This affects all metabolites but the changes are normalized after 5 h.
Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark. asej@rn.dk.|Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. asej@rn.dk.
Ashir
A
Ejaz
Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark.|Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Anders C
AC
Laursen
Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark.
Andreas
A
Kappel
Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark.
Thomas
T
Jakobsen
Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark.
Poul Torben
PT
Nielsen
Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark.|Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Sten
S
Rasmussen
D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply* / Q000378:metabolism*; D011446:Prospective Studies; D014111:Tourniquets / Q000009:adverse effects*