Tourniquet-Induced Ischemia-Reperfusion Injury during Total Knee Arthroplasty

Qiong-Fang Wu , Dong-Xin Wang
Departments of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
J Anesth Perioper Med 2018; 5(1): 41- 47 . Published on Jan 31, 2018 . doi:10.24015/ JAPM.2018.0011
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Aim of review: To review the advantages and disadvantages of tourniquet use during total knee arthroplasty (TKA) and the management of tourniquet-induced ischemia-reperfusion injury.
Methods: The PubMed database was systematically searched for related literatures using the following keywords: “total knee replacement” or “total knee arthroplasty”, “tourniquet”, and “ischemia reperfusion” or “ischemia reperfusion injury”. The selected literature was then read by the authors and manually identified.  
Recent findings: Tourniquet use during TKA reduces the volume of blood loss and the requirement of blood transfusion, and shortens the duration of surgery. However, it induces ischemia-reperfusion injury that provokes local as well as systemic inflammation, producing harmful effects to the involved limbs (muscle swollen and atrophy and persistent weakness) and local as well as remote organs (deep vein thrombosis, lung injury, wound complications, etc.). To decrease tourniquet-related harmful effects, the duration of ischemia should be kept as short as possible. Other measures such as providing propofol sedation or antioxidant, and performing ischemic preconditioning may be helpful to attenuate ischemia-reperfusion injury but require further demonstration. 
Conclusion: Tourniquet use during TKA has both advantages and disadvantages. Tourniquet-induced ischemia-reperfusion injury is a major source of harmful effects. The benefits and risks of the tourniquet use should be carefully evaluated before making the decision. 
Citation: Qiong-Fang Wu, Dong-Xin Wang. Tourniquet-Induced Ischemia-Reperfusion Injury during Total Knee Arthroplasty. J Anesth Perioper Med 2018;5:41- 7. 
doi: 10.24015/ JAPM.2018.0011
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