38.
Muscle Damage From The Arterial Tourniquet in Total Knee
Arthroplasty Occur Underneath The Cuff
Lasse E. Rasmussen, Henriette A. Holm, Per W Kristensen, Per Kjærsgaard-
Andersen
Ortopedic Surgery Sygehus Lillebælt, Vejle; Ortopedic Surgery, Sygehus
Lillebælt, Vejle; Ortopedic Surgery, Sygehus Lillebælt, Vejle; Ortopedic
Surgery, Sygehus Lillebælt, Vejle
Background:
It is currently debated whether it is safe to use an arterial
tourniquet in total knee arthroplasty (TKA).
Purpose / Aim of Study:
The ischemic response in the quadriceps muscle was
investigated by direct measurement of ischemia underneath the tourniquet and
distally in ischemic tissue and correlated to the muscular function 14 days
postoperatively.
Materials and Methods:
Measurements were performed in 12 patients (Mean
age (years) 59.2. Range: 39 – 77). Using the microdialysis technique (CMA63
catheter, 0,5 l/min, CMA Microdialysis, Solna, Sweden), metabolism
(
Lactate, Pyrovate, Glucose, Glycerol) was measured in skeletal muscle
underneath the arterial tourniquet (pressure: 350 mmHg), in the ischemic
muscle distally to the tourniquet and in the opposite muscular tissue
(
reference). Creatine Kinase (CK), Asparagine Aminotransferase (ASAT) and
Lactate Dehydrogenase (LDH) were measured before, during and after the
surgical procedure. Quadriceps function was measured as an isolated isometric
leg- extension test 14 days postoperatively.
Findings / Results:
Lactate/ pyruvate (L/P) ratio increased faster underneath
the tourniquet compared to ischemic tissue distally to the tourniquet. Glycerol
levels underneath the tourniquet were significantly elevated compared to
ischemic tissue distally to the tourniquet. A negative correlation was found
between the individual ischemic response measured as the L/P ratio
underneath the tourniquet after 45 minutes of ischemia and isolated quadriceps
function 14 days postop.
Conclusions:
The skeletal muscle underneath the tourniquet suffered to a
larger extent from ischemia than the ischemic tissue distally to the tourniquet.
The ischemia under the tourniquet may relate to the level of muscle injury and
the individual ischemic response may determine the muscular function during
the first 14 days postoperatively.
