J Knee Surg 2020; 33(08): 762-767
DOI: 10.1055/s-0039-1688565
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Impact of Tourniquet Use on Systemic Inflammatory Parameters, Functional Physical Recovery, and Cardiovascular Outcomes of Patients Undergoing Knee Arthroplasty: A Case-Control Study

Edoardo Bressi
1   Department of Cardiovascular Sciences, University Campus Bio-Medico of Rome, Rome, Italy
,
Umile Giuseppe Longo
2   Department of Orthopedics and Traumatology, University Campus Bio-Medico of Rome, Rome, Italy
,
Fabio Mangiacapra
1   Department of Cardiovascular Sciences, University Campus Bio-Medico of Rome, Rome, Italy
,
Vincenzo Candela
2   Department of Orthopedics and Traumatology, University Campus Bio-Medico of Rome, Rome, Italy
,
Alessandra Berton
2   Department of Orthopedics and Traumatology, University Campus Bio-Medico of Rome, Rome, Italy
,
Giuseppe Salvatore
2   Department of Orthopedics and Traumatology, University Campus Bio-Medico of Rome, Rome, Italy
,
Marialessia Capuano
1   Department of Cardiovascular Sciences, University Campus Bio-Medico of Rome, Rome, Italy
,
Riccardo Proietti
2   Department of Orthopedics and Traumatology, University Campus Bio-Medico of Rome, Rome, Italy
,
Vincenzo Denaro
2   Department of Orthopedics and Traumatology, University Campus Bio-Medico of Rome, Rome, Italy
› Author Affiliations
Further Information

Publication History

26 April 2018

18 March 2019

Publication Date:
07 May 2019 (online)

Abstract

The benefits of tourniquet use during orthopaedic surgery are controversial. We aim to investigate its effects on systemic inflammation, functional physical recovery, and cardiovascular complications of patients undergoing knee arthroplasty. We enrolled 129 consecutive patients (57 treated with tourniquet vs. 72 in the control group) undergoing total unilateral knee arthroplasty, followed by inpatient rehabilitation protocol at our institution. Blood samples were drawn in all patients at baseline and within 24 hours after surgery for complete blood cell count assessment. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated as the ratio between the absolute number of neutrophil and platelets over the absolute number of lymphocytes, respectively. The numeric rating scale (NRS; 0–10) assessed the current pain, day after the surgery. All subjects underwent physical functional evaluation measured by the modified Barthel's index (MBI) at the end of the rehabilitation. We also recorded the incidence of major bleeding, typical angina, and occurrence of atrial fibrillation after surgery. In the overall population, a significant postprocedural increase in NLR and PLR was observed (p < 0.001). Baseline NLR and PLR were similar in patients with and without tourniquet (1.5 ± 0.8 vs. 1.95 ± 1.2, p = 0.081; 120 ± 42 vs. 131 ± 55, p = 0.240); however, patients treated with tourniquet showed significantly lower NLR at 24 hours (6.1 ± 3.6 vs. 8.1 ± 5.7, p = 0.043). NRS scores were significantly higher in the tourniquet group without compromising functional and physical recovery whereas no significant differences were appreciated in MBI scores between the two groups. Moreover, the rates of postoperative atrial fibrillation (1 [2%] vs. 9 [12%], p = 0.042) and major bleeding (2 [4%] vs. 11 [15%], p = 0.038) were significantly lower in the tourniquet group. Tourniquet seems a useful tool which is able to mitigate the inflammatory activation and prevent the occurrence of atrial fibrillation and major bleeding without altering functional physical recovery of patients undergoing total knee arthroplasty.

Authors' Contributions

U.G.L. and F.M. made substantive intellectual contributions to the published study and wrote the paper; E.B., V.C., R.P., and G.S. evaluated the clinical conditions and the clinical course of the patient during the follow-up period; A.B., M.C., and V.D. contributed to clinical and instrumental exams interpretations and reviewed the article.