Perioperative Inflammatory Response in Total Knee Arthroplasty Patients

Abstract

Preconditioning of the lower extremity in the setting of TKA under regional anesthesia may have limited value in reducing the systemic inflammatory response and level of lung injury. However, preconditioning may be associated with beneficial effects such as reduction in postoperative pain levels, and thus, further investigations are warranted.

Does Limb Preconditioning Reduce Pain After Total Knee Arthroplasty? A Randomized, Double-blind Study

“…Before tourniquet application for preconditioning and before the surgery in both groups, the operative limb was exsanguinated by passive leg raise followed by application of an Esmarch elastic bandage from distal to proximal. All surgeries were performed through a midline incision with a medial parapatellar arthrotomy [14]. All patients received a surgeon-selected cemented posterior-stabilized prosthetic design with patellar resurfacing.…”

“…First, intraarticular fluid was aspirated from the drain at the end of surgery and examined for levels of tumor necrosis factor-a (TNF-a) and for interleukin-6 (IL-6) as described previously [14]. For this purpose, samples were centrifuged at 3000 rpm for 5 minutes and the supernatant frozen at \ À18°F.…”

“…An earlier work examining the impact of limb preconditioning [14] found that patients in the control group had a median VAS score of 2.7 (± 1.5) on average at 48 hours after TKA as compared with 1.6 (± 1.4) in the intervention group. Using this result, we anticipated a requirement of 30 patients per group to detect a statistically significant difference in pain scores with 80% power and 5% Type I error.…”

“…In a previous study focusing on the systemic perioperative inflammatory response in patients undergoing knee arthroplasty, we incidentally found evidence suggesting that patients undergoing a brief period of preconditioning of the operative leg before the inflation of a tourniquet for TKA experienced reduced levels of pain [14]. ''Preconditioning'' was defined in that study as the inflation of a tourniquet for 5 minutes in the operated limb followed by deflation and reperfusion before reinflation for surgery.…”

“…Current analgesic therapies focus on a combination of regional anesthetic and various oral and parenteral pharmacologic agents. However, studies of nonpharmacologic approaches to alleviate pain postoperatively remain rare [14].…”