Acta Orthopaedica et Traumatologica Turcica
Research Articles

An investigation into the cellular-level adverse effects of tourniquet use on the infrapatellar fat pad in primary total knee arthroplasty: A prospective randomized study

1.

Department of Orthopaedics and Traumatology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey

2.

Department of Histology and Embryology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey

3.

Department of Medical Laboratory Techniques, Atatürk Vocational School of Health Services, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey

AOTT 2023; 57: 283-288
DOI: 10.5152/j.aott.2023.22164
Read: 829 Downloads: 259 Published: 11 October 2023

Objective: This study aimed to examine the cellular-level adverse effects of tourniquet use on the infrapatellar fat pad (IPFP) in patients undergoing primary total knee arthroplasty (TKA).

Methods: Infrapatellar fat pad samples were collected in a prospective, randomized design to compare 2 groups of primary TKA patients with a tourniquet (T) and without a tourniquet (NT). The study included 80 knees of 58 patients with a mean age of 65.91 ± 9.04 years. The authors collected 3 samples from the T group (after exposure to the fat pad “t1,” just before deflating the tourniquet “t2,” just before fascia closure “t3”) and 2 samples from the NT group (t1 and t3) for each patient. BAX, Bcl-2, and HIF-1α staining showed the extent of cellular hypoxia and apoptosis in IPFP cells, whereas the oxidative stress index (OSI) was determined using a biochemical method. The Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS), and Kujala score were used as clinical outcome measures.

Results:The mean HIF-1α, BAX/Bcl-2, and OSI scores across all time points were significantly higher in the T group than in the NT group (p<0.001) (d=1.16, 2.9, and 0.9, respectively). The mean BAX/Bcl-2 (P=.030) and HIF-1α (P < .001) scores significantly peaked at t2 in the T group (d=−1.2 and −3.9, respectively). The OSI had higher levels at t1 (P=.011) and t3 (P=.073) (d=0.2 and 0.1, respectively) than at t2 in the T group. The third-month postoperative follow-up revealed that the mean KOOS, KSS, and Kujala score improved significantly compared to the baseline preoperative values (P < .001); however, there was no difference between the T and NT groups regarding the maximum and total knee range of motion or clinical outcome scores.

Conclusion: Evidence from this study has shown that tourniquet use during primary TKA may be associated with significantly increased cellular hypoxia, oxidative stress, and apoptosis in the IPFP.

Level of Evidence: Level I, Therapeutic study.

Cite this article as: Altin R, Yesil M, Ozcan O, Karaca C, Sen S, Firat F. An investigation into the cellular-level adverse effects of tourniquet use on the infrapatellar fat pad in primary total knee arthroplasty: A prospective randomized study. Acta Orthop Traumatol Turc., 2023;57(5):283-288.

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ISSN 1017-995X EISSN 2589-1294