Endothelin‐1 is secreted after total knee arthroplasty regardless of the use of a tourniquet

Abstract

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-l), 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 (5min43h) 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 24h was identical in both groups (p > 0.5).We conclude that the tissue hypoxia resulting from the use of a tourniquet modulates ET-I secretion, but that traumatization during the operation has a much stronger influence on the total amount secreted.ET-I antagonists thus should be discussed for the drug prophylaxis of wound healing disorders, regardless of the use of a tourniquet.

Tourniquet Use During Cementation Only During Total Knee Arthroplasty: A Randomized Trial

“…Several randomized controlled trials of tourniquet versus no tourniquet use during this operation have shown no statistical difference or even less total blood loss when no tourniquet is used [1,2,10,12,14,15,[25][26][27][28][29] . Moreover, there are potential complications associated with tourniquet use: nerve palsy [8,19], delayed recovery of muscle power from microscopic changes in muscle myofibrils [21], wound complications [1,12,25], and venous thrombotic embolism [1,10,12].…”

“…To our knowledge, there are no studies in the literature comparing the use of the tourniquet during cementation only with tourniquet use during the entire operation. All previous randomized studies have compared no tourniquet use at all with tourniquet use during the operation [1,2,10,11,14,15,[24][25][26].…”

Reply to Letter to the Editor

“…Matziolis et al [7] found a comparable drop in hemoglobin between study groups. Yang et al [14] failed to differentiate between tourniquet use and no tourniquet use.…”

Letter to the Editor

“…In the Introduction, the authors compared randomized controlled trials featuring patients undergoing TKA with or without tourniquet that show no statistical difference in blood loss or less blood loss when no tourniquet is used. The authors provided three additional studies [2,6,13] in their References section. However, none of these three papers have studied blood loss with or without tourniquet in TKA.…”