Oxidative Medicine and Cellular Longevity

Review Article

The Possible Pathophysiological Outcomes and Mechanisms of Tourniquet-Induced Ischemia-Reperfusion Injury during Total Knee Arthroplasty

Table 2

Effects of TQ-induced I/R injury on local and systemic circulation.


Study model/specimen/sample size/age	TQ pressure/ischemia time	Main findings (compared to baseline level)			Interpretation	References
		Clinical outcome	Mechanism
		Clinical outcome	Local circulation	Systemic circulation

Randomized controlled trial/antecubital venous blood//blood from surgical drain//approx. 70 ± 7 yr	250 mmHg, approx. 90 ± 15 min	N/A	Surgical drainage tube ↓↓ GSH ↑↑ GSSG ↑↑ MDA	Antecubital vein ↓ GSH ↑ GSSG ↑ MDA	Changes in glutathione oxidation and lipid peroxidation happened earlier and more intensely in the blood from the reperfused area than from the systemic circulation	[24]
Cross-sectional study/antecubital and femoral venous blood//69 ± 2 yr	Double SBP mmHg, 85 ± 8 min	N/A	Femoral vein of operated leg ↑↑ hypoxanthine, XO activity, and xanthine ↑ GSSG/GSH	Antecubital vein ↑ hypoxanthine, XO activity, and xanthine ↔ GSSG/GSH	Higher increase in prooxidants and oxidative stress in the blood from the reperfused area compared to the systemic circulation	[25]
Cross-sectional study/great saphenous venous blood of both legs, blood from surgical drain//57–71 yr	250–300 mmHg, 78–125 min	N/A	Surgical drainage tube ↑↑ IL-6 ↑ IL-10	Great saphenous vein of nonoperated leg ↑ IL-6 ↔ IL-10	Higher increase in pro- and anti-inflammatory cytokines in the blood from the reperfused area compared to the systemic circulation	[26]
Cross-sectional study/peripheral blood lymphocytes//60–75 yr	100–120 min	N/A	N/A	↑ genotoxicity index ↑ cytotoxicity index ↔ cytostaticity index	Genotoxic and cytotoxic effects on peripheral lymphocytes were most pronounced at onset of reperfusion and remained so 1 hour afterward	[27]
Case-control study/venous blood//74 ± 7 yr	250–300 mmHg, 80 ± 20 min	↑ knee function scores No surgical site infection at 1 yr	N/A	↑ IL-6, CPR, CPK, and white cell count	Oxidative stress after TKA surgery primarily originated from surgical stress only	[28]

CPK: creatine phosphokinase; CRP: c-reactive protein; GSH: reduced glutathione; GSSG: oxidized glutathione; IL: interleukin; I/R: ischemia and reperfusion; MDA: malondialdehyde; N/A: not available; SBP: systolic blood pressure; TKA: total knee arthroplasty; TQ: tourniquet; XO: xanthine oxidase.