Tourniquet-induced ischaemia during total knee arthroplasty results in higher proteolytic activities within vastus medialis cells: a randomized clinical trial

Jawhar, Ahmed; Hermanns, Stephan; Ponelies, Norbert; Obertacke, U.; Roehl, Henning

doi:10.1007/s00167-015-3859-2

Cited by 37 publications

(40 citation statements)

References 35 publications

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“…In the present research, the soleus and the extensor carpi radialis longus evidenced different patterns of regeneration for each muscle. Likewise, both muscles evidenced distinct changes in size and shape of muscle fibers, possibly related with oedema and protein degradation after short periods of ischemia, as have seen in muscle fibers obtained from postsurgical patients [37].…”

Section: Discussionsupporting

confidence: 52%

Recovery of Skeletal Striated Muscle Tissue in a Model of Reversible Injury

Otoya¹,

Salazar²

2017

Biol Med

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Reversible injury is a dynamic condition in tissues exposed to multiple harm situations including ischemia and post-ischemic recovery, in which the skeletal striated muscle tissue evidences histopathological characteristics to adapt to damage. During the inflammation and the regeneration phases of healing, the myocytes show morphological changes with an apparently complete recovery at the end of the treatment. Though the satellite cells play a key role in the recovery, not in all cases the regeneration is completely achieved. That is why in this research we measured the histopathological patterns evidenced by enzyme histochemistry and morphometric measurements, during the spontaneous recovery of skeletal muscle fibers underwent to short periods of ischemia of one and three hours and prolonged periods of reperfusion up to 32 days (768 hours). The selected muscles were the extensor carpi radialis longus and the soleus from Wistar rats.There were significant differences in the distribution of type of fibers, shape, size, leukocyte infiltration, necrosis and presence of central nuclei. The soleus muscle adapts better during early reperfusion than extensor carpi radialis longus does. Nevertheless, both muscles evidenced an incomplete recovery at day 32. The extrapolation of these findings suggests the importance of further following up of patients and the improvement of recovery the muscle function after surgery and/or other harm conditions.

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Section: Discussionsupporting

confidence: 52%

Recovery of Skeletal Striated Muscle Tissue in a Model of Reversible Injury

Otoya¹,

Salazar²

2017

Biol Med

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“…Although widely accepted, tourniquet-related complications have been reported in the literature, including wound complications, thigh pain, limb swelling, nerve palsy and muscle myofibril injury [2, 3]. In view of the tourniquet-related complications, some surgeons would like to perform TKA without a tourniquet [4, 5]. …”

Section: Introductionmentioning

confidence: 99%

Influence of tourniquet use in primary total knee arthroplasty with drainage: a prospective randomised controlled trial

et al. 2017

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BackgroundWe aimed to compare the effect of tourniquet use or lack of it on recovery following uncomplicated primary total knee arthroplasty (TKA).MethodsIn a prospective randomised double-blinded study, 150 patients undergoing primary TKA were assigned to either a tourniquet or non-tourniquet group. At the early phase, 3 and 6 months after surgery, an independent observer assessed the primary outcome measure (i.e. total blood loss) and secondary outcome measures (i.e. wound complications, visual analogue scale pain score and knee range of motion).ResultsThe tourniquet group exhibited reduced intraoperative blood loss (215.7 ± 113.7 ml vs. 138.6 ± 93.9 ml, P < 0.001) and shorter operating time (77.2 ± 14.5 min vs. 82.0 ± 12.7 min, P = 0.038). However, the non-tourniquet group showed less postoperative blood loss (180.2 ± 117.0 ml vs. 253.7 ± 144.2 ml, P = 0.001) and drainage volume (89.2 ± 66.3 ml vs. 164.5 ± 97.8 ml, P = 0.004), less thigh pain (all P < 0.001) in the initial 3 weeks, better knee range of motion (ROM) in the initial 3 days (day 1 81.6 ± 17.1 vs. 75.95 ± 14.55, P = 0.036; day 3 99.8 ± 13.7 vs. 93.95 ± 11.15, P = 0.005) and fewer wound tension vesicles (10.3 vs. 29.2%, P = 0.005). Earlier straight-leg raising (4.6 ± 3.8 h vs. 6.4 ± 4.3 h, P = 0.01) and shorter length of stay (6.3 ± 1.7 days vs. 7.1 ± 1.9 days, P = 0.001) were found in the non-tourniquet group. Similar total blood loss and blood transfusion rate were observed for both groups. All other parameters revealed no significant differences.ConclusionsOur study suggests that a non-tourniquet TKA would lead to early rehabilitation without increasing side effects.Trial registrationChinese Clinical Trials Registry, ChiCTR-IOR-16007851, 1/29/2016

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“…Taken together, the above data suggest that, during TKA, altered signaling via the Akt-FOXO3a pathway up regulates MAFbx and MuRF1, which stimulate ubiquitin-proteasomal-dependent protein degradation and may play a role in mitochondrial function via the BNIP3 pro-cell death pathway (Figure 4). A newly published paper by Jawhar and colleagues (16) shows that compared to TKA performed without tourniquet, proteolytic activity was elevated in vastus medialis muscle tissue after 60 minutes of continuous tourniquet application. To our knowledge, besides the studies we have conducted, there is a dearth of studies similar to Jawhar et al , (16) looking at the acute effects of tourniquet-induced anoxia on markers of catabolism and stress-related signaling at the tissue level.…”

Section: Introductionmentioning

confidence: 99%

“…A newly published paper by Jawhar and colleagues (16) shows that compared to TKA performed without tourniquet, proteolytic activity was elevated in vastus medialis muscle tissue after 60 minutes of continuous tourniquet application. To our knowledge, besides the studies we have conducted, there is a dearth of studies similar to Jawhar et al , (16) looking at the acute effects of tourniquet-induced anoxia on markers of catabolism and stress-related signaling at the tissue level. Either way, their data (16) corroborate our view that cell catabolism is uniquely altered during TKA under anoxic (tourniquet) conditions.…”

Section: Introductionmentioning

confidence: 99%

“…To our knowledge, besides the studies we have conducted, there is a dearth of studies similar to Jawhar et al , (16) looking at the acute effects of tourniquet-induced anoxia on markers of catabolism and stress-related signaling at the tissue level. Either way, their data (16) corroborate our view that cell catabolism is uniquely altered during TKA under anoxic (tourniquet) conditions.…”

Section: Introductionmentioning

confidence: 99%

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Tourniquet Use During Knee Replacement Surgery May Contribute to Muscle Atrophy in Older Adults

Dreyer

2016

Exercise and Sport Sciences Reviews

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Muscle atrophy after total knee arthroplasty (TKA) occurs at a rate of 1% per day for the first two weeks. Our hypothesis is that tourniquet-induced IR injury occurring during TKA influences metabolism and may contribute to atrophy. Identifying pathways that are up regulated during this critical “14-day window” after surgery may help us to delineate therapeutic approaches to avoid muscle loss.

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Tourniquet-induced ischaemia during total knee arthroplasty results in higher proteolytic activities within vastus medialis cells: a randomized clinical trial

Abstract: I.

Cited by 37 publications

References 35 publications

Recovery of Skeletal Striated Muscle Tissue in a Model of Reversible Injury

Recovery of Skeletal Striated Muscle Tissue in a Model of Reversible Injury

Influence of tourniquet use in primary total knee arthroplasty with drainage: a prospective randomised controlled trial

Tourniquet Use During Knee Replacement Surgery May Contribute to Muscle Atrophy in Older Adults

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