Cytokine patterns after tourniquet‐induced skeletal muscle ischaemia reperfusion in total knee replacement

Clementsen, Torkil; Reikerås, Olav

doi:10.1080/00365510701528587

Cited by 21 publications

(21 citation statements)

References 42 publications

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“…In our study we found that TNFα and IL-6 were significantly elevated in serum at 10 min reperfusion as compared to baseline. This result is in line with two reports of tourniquet application in lower limb surgery, where a rise in IL-6 was shown at 2 h and 4 h reperfusion, respectively, in the draining blood of the ischemic limbs [19,32]. We also found a significant rise in the levels of IL-17 from baseline, highlighting the involvement of another pro-inflammatory molecule, which is known to induce EC to secrete cytokines.…”

Section: Discussionsupporting

confidence: 92%

Assessment of endothelium and inflammatory response at the onset of reperfusion injury in hand surgery

et al. 2012

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BackgroundActivation of the endothelium, complement activation and generation of cytokines are known events during ischemia-reperfusion (I/R) that mediate tissue injury. Our aim was to elucidate their respective participation at the onset of the reperfusion phase. Tourniquet application in hand surgery causes short-term ischemia, followed by reperfusion and was therefore used as the model in this study.MethodsTen patients were included in the study after obtaining informed consent. A tourniquet was placed on the upper arm and inflated to 250 mmHg for 116 ± 16 min, during which the surgery was performed. Venous blood and tissue samples from the surgical area were taken at baseline as well as 0, 2, and 10 min after reperfusion and analyzed for the following parameters: Endothelial integrity and/or activation were analyzed by measuring heparan sulfate and syndecan-1 in serum, and vWF, heparan sulfate proteoglycan as well as CD31on tissue. Complement activation was determined by C3a and C4d levels in plasma, levels of C1-inhibitor in serum, and IgG, IgM, C3b/c, and C4b/c deposition on tissue. Cytokines and growth factors IL-5, IL-6, IL-7, IL-8, IL-10, IL-17, G-CSF, GM-CSF, MCP-1, TNFα, VEGF, and PDGF bb were measured in the serum. Finally, CK-MM levels were determined in plasma as a measure for muscle necrosis.ResultsMarkers for endothelial activation and/or integrity as well as complement activation showed no significant changes until 10 min reperfusion. Among the measured cytokines, IL-6, IL-7, IL-17, TNFα, GM-CSF, VEGF, and PDGF bb were significantly increased at 10 min reperfusion with respect to baseline. CK-MM showed a rise from baseline at the onset of reperfusion (p < 0.001) and dropped again at 2 min (p < 0.01) reperfusion, suggesting ischemic muscle damage.ConclusionsIn this clinical model of I/R injury no damage to the endothelium, antibody deposition or complement activation were observed during early reperfusion. However, an increase of pro-inflammatory cytokines and growth factors was shown, suggesting a contribution of these molecules in the early stages of I/R injury.

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Section: Discussionsupporting

confidence: 92%

Assessment of endothelium and inflammatory response at the onset of reperfusion injury in hand surgery

et al. 2012

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“…However, no significant correlations between acute postoperative pain and TNF-α, both in serum and in synovial fluid, was found in our study. Additionally, it would be specially mentioned that we initially detected the IL-1β, which was reported as a strong pro-inflammatory cytokine [42, 43], but its level was very low and difficult to be detected in the systemic circulation, as well as in synovial fluid, even in subsequent periods following surgery, and this was also been reported by other researchers [24, 44]. …”

Section: Discussionsupporting

confidence: 59%

“…Additionally, it is still debated whether tourniquet-induced ischemia represents a substantial contributor to inflammatory response and muscle damage, as well as subsequent release of relative markers. Clementsen et al investigated the release of inflammatory cytokines, including IL-1β, IL-6, IL-8, and TNF-α, after tourniquet use in TKA, but levels of these cytokines did not change regardless of tourniquet use [44]. Laurence et al evaluated tourniquet-induced ischemia during TKA and reported that no significant difference in Mb between patients with and without tourniquet (less than 150 min), and the elevation of serum Mb associated with tourniquet was negligible [45].…”

Section: Discussionmentioning

confidence: 99%

Correlations between inflammatory cytokines, muscle damage markers and acute postoperative pain following primary total knee arthroplasty

Yang

Zeng

et al. 2017

BMC Musculoskelet Disord

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BackgroundDespite the success of total knee arthroplasty (TKA) in reducing knee pain and improving functional disability, the management of acute postoperative pain is still unsatisfactory. This study was aimed to quantitatively analyze the possible correlations between inflammatory cytokines, muscle damage markers and acute postoperative pain following primary TKA.MethodsPatients scheduled for unilateral primary TKA were consecutively included, the serial changes of the numerical rating scale (NRS) at rest (NRSR) and at walking (NRSW), serum inflammatory cytokines and muscle damage markers were assessed before surgery (T0) and at postoperative day 1, 2, 3 and 5 (T1-T4, respectively); while pain disability questionnaire (PDQ) and synovial fluid inflammatory cytokines were evaluated at T0. The correlations between inflammatory cytokines, muscle damage markers and pain scores were examined, and Bonferroni correction was applied for multiple comparisons.ResultsNinety six patients were included for serum markers and pain evaluations at T0-T4, while 54 (56.25%) for synovial fluid cytokines at T0. The NRSR at T1 and T2 were positively correlated with preoperative NRSW, while the NRSW at T1 to T4 were positively correlated with preoperative NRSR, NRSW and PDQ (all p < 0.05). The NRSR was positively correlated with serum PGE2, IL-6, and CK at T1; the NRSW was positively correlated with serum CRP at T1, with PGE2 and IL-6 at T1 to T3, with CK at T2 and T4, and with Mb and LDH at T1 to T4 (all p < 0.003). Meanwhile, positive correlations were observed between preoperative NRSW and synovial fluid PGE2, IL-6, IL-8, or TNF-α, as well as between PDQ and PGE2 (all p < 0.003), but no associations between postoperative pain scores and preoperative synovial fluid cytokines was found (all p ≥ 0.003). Additionally, the NRSR at T1 and T2, and NRSW at T1 to T4 were positively correlated with body mass index (all p < 0.05).ConclusionsSerum inflammatory cytokines and muscle damage markers are positively correlated with acute postoperative pain following primary TKA, and the key cytokines (CRP, PGE2, and IL-6) and markers (Mb, CK and LDH) may serve as the targets for developing novel analgesic strategies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1597-y) contains supplementary material, which is available to authorized users.

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“…[19] Tourniquet use may result in skeletal muscle ischemia-reperfusion injury, and thus increase the SIR to surgery. [20,21] However, the mean time for tourniquet use were similar between the groups in this study.…”

Section: Discussionmentioning

confidence: 51%

The effects of general and spinal anesthesia on systemic inflammatory response in patients undergoing total knee arthroplasty

Eroglu

Kokulu

Koca

et al. 2016

Eklem Hastalik Cerrahisi

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Cytokine patterns after tourniquet‐induced skeletal muscle ischaemia reperfusion in total knee replacement

Abstract: Knee replacement trauma performed under ischaemia, is associated with modest systemic inflammatory reactions with no spillover of increased IL-6 from the traumatized area in the reperfusion phase.

Cited by 21 publications

References 42 publications

Assessment of endothelium and inflammatory response at the onset of reperfusion injury in hand surgery

Assessment of endothelium and inflammatory response at the onset of reperfusion injury in hand surgery

Correlations between inflammatory cytokines, muscle damage markers and acute postoperative pain following primary total knee arthroplasty

The effects of general and spinal anesthesia on systemic inflammatory response in patients undergoing total knee arthroplasty

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