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J Knee Surg 2022; 35(14): 1577-1586
DOI: 10.1055/s-0041-1728814
Original Article

Effects of Tourniquet Application on Faster Recovery after Surgery and Ischemia-Reperfusion Post–Total Knee Arthroplasty, Cementation through Closure versus Full-Course and Nontourniquet Group

Qinggang Cao    *
1   Department of Orthopaedic Surgery, Jinling Hospital, Nanjing, China
,
Qiong Wu   *
2   Department of Scientific Research and Training, Division of Health Service, General Hospital of Eastern theater of People's Liberation Army, Nanjing, Jiangsu, China
,
Yun Liu   *
3   Health Technology Cadre Training, Jingling Hospital, Nanjing, China
,
Zhiwei He   *
1   Department of Orthopaedic Surgery, Jinling Hospital, Nanjing, China
,
Yu Cong   *
1   Department of Orthopaedic Surgery, Jinling Hospital, Nanjing, China
,
Jia Meng
1   Department of Orthopaedic Surgery, Jinling Hospital, Nanjing, China
,
Jianning Zhao
1   Department of Orthopaedic Surgery, Jinling Hospital, Nanjing, China
3   Health Technology Cadre Training, Jingling Hospital, Nanjing, China
,
Nirong Bao
1   Department of Orthopaedic Surgery, Jinling Hospital, Nanjing, China
3   Health Technology Cadre Training, Jingling Hospital, Nanjing, China
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Funding This work was supported by the Natural Science Foundation of Jiangsu Province of China (no.: BK20161385) and Social Development-General Program of Science and Technology Department of Jiangsu Province (no.: BE2015686).
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Abstract

Pneumatic tourniquets are used in total knee arthroplasty (TKA) for surgical field visualization and improved cementation; however, their use is controversial. This study aimed to assess the effects of tourniquet application on faster recovery post-TKA. Our hypothesis was that inflammation and limb function would be similar with different tourniquet applications. A prospective randomized double-blinded trial assessed tourniquets effects on postoperative pain, swelling, and early outcome in TKA. In present study, 50 TKAs were enrolled in each group as follows: full course (FC), cementation through closure (CTC), and no tourniquet (NT), CTC as treatment group while FC and NT as control groups. Topical blood samples of 3 mL from the joint cavity and drainage bags were obtained at special time point. At last, all samples such as tumor necrosis factor-a (TNF-a), C-C motif chemokine ligand 2 (CCL2), pentraxin 3 (PTX3), prostaglandin E2 (PGE2), superoxide dismutase 1 (SOD1), and myoglobin (Mb) were detected by ELISA. Active and passive range of motion (ROM) values, pain score by the visual analog scale (VAS), change of thigh circumference were recorded at special time point as well. In topical blood, the change of inflammatory factors, such as TNF-a, PTX3, CCL2, PGE2, SOD1, and Mb, was lower in CTC and NT groups than in FC group (p < 0.01 and 0.05). Although VAS and ROM were comparable preoperatively in three groups (p > 0.05), the perimeter growth rate was lower, pain scores (VAS) were reduced, and ROM values were improved in CTC and NT groups compared with FC group at T4, T5, and T6 postoperatively (p < 0.01 and 0.05). Improved therapeutic outcome was observed in the CTC group, indicating patients should routinely undergo TKA with cementation through closure tourniquet application.

Keywords

tourniquet - total knee arthroplasty - swelling - pain

Availability of Data and Materials

We declare that the materials described in the manuscript, including all relevant raw data, will be freely available to any scientist wishing to use them for noncommercial purposes, without breaching participant confidentiality.


Authors' Contributions

Q.C., N.B., Z.H., and J.Z. performed the experiments. Q.C. and Y.L. analyzed the data and drafted the manuscript. Q.W. collected the specimens. J.Z., N.B., and J.M. revised the manuscript critically for important intellectual content. All authors read and approved the final manuscript.


Ethical Approval

Ethics Committee of Jinling Hospital Affiliated to the Medical College of Nanjing University; Clinical Trial Registration number 2018NZKY-004–02. Registered on March 13, 2018. All procedures, involving human participants, were in accordance with the ethical standards of the institutional research committee and the 1964 Helsinki declaration and its amendments or comparable ethical standards. Written informed consent was obtained from all participants.


* Co-first authors.




Publikationsverlauf

Eingereicht: 10. August 2018

Angenommen: 12. März 2021

Artikel online veröffentlicht:
15. Mai 2021

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