-

Öz

Amaç: Uzamış turnike zamanı ile eşzamanlı bilateral total diz artroplastisi(TDP) diz fonksiyonlarını olumsuz etkileyebilecek iskemik-perfüzyon yaralanmasını tetikleme potansiyeline sahiptir. Çalışmalar bu yaralanmanın büyüklüğünün vücudun herhangibir yerinde olan iskemik bir hadiseden sonra daha az olduğunu ortaya koymuş ve bu etkiye iskemikönkoşullama (İÖ) adı verilmiştir. Bu çalışmanın amacı oksidatif streslerin kas yaralanması, diz fonksiyonları üzerine etkilerini ve İÖE’nin tek aşamalı bilateral TDP olgularında yaralanma metabolitlerini etkileme ve kötü fonksiyonel sonuçları engelleme potansiyelini araştırmaktır.Çalışma planı: Turnike eşliğinde eş zamanlı bilateral TDP uygulanan 30 hasta bu çalışmaya dahil edildi. Tüm işlemler sağ ekstremiteden başlatıldı. İşlemin bitimini takiben, sol turnike işlem sonunda ilk turnike indirildikten 20 dakika sonra şişirildi. Turnike zamanı kaydedildi. Pre ve postoperatifmalondialdehid (MDH), kreatinkinaz (KK) ve laktatdehidrogenez (LDH) seviyeleri ölçüldü. Diz fonksiyonları postoperatif 1. ayda WOMAC skoru ile değerlendirildi.Bulgular: Her iki ekstremitede MDH, KK ve LDH seviyeleri postoperatif dönemde preopratif döneme göre artmış bulundu. Her iki ekstremitede de serum MDH, CK ve LDH seviyeleri ile turnike süresi arasında ilişki saptanmadı. Solekstremite ile karşılaştırıldığında sağ ekstremitede artmış serum MDH, CK ve LDH düzeyleri ile görülen daha yüksek postoperatifoksidatifstress saptandı. Turnike zamanı ve postoperatif serum MDH, KK ve LDH seviyelerinin her iki dizde WOMAC indeksi ile korrele olmadığı gösterilse de postoperatif birinci ay WOMAC skorunda postoperatif 1 ay değişikliği sağ dize göre sol dizde daha yüksek bulundu.Çıkarımlar: Biyokimyasal ve fonksiyonel sonuçlar potansiyel İÖE’ye bağlanabilir. Bilateral TDP sırasında turnikeler arasındaki 20 dakikalık süre İÖE yaratabilir ve iskemi-perfüzyon yaralanmasının büyüklüğünü azaltabilir ve daha iyi fonksiyonel sonuçlara neden olabilir

Anahtar Kelimeler

• Bilateral total diz artroplastisi; iskemi-reperfüzyon yaralanması; iskemikönkoşullama etkisi; turnike

Impact of oxidative stress on early postoperative knee function and muscle injury biochemical markers: Is it possible to create an ischemic preconditioning effect in sequential ischemic surgical procedures?

Abstract

Objective: Simultaneous bilateral total knee arthroplasty (TKA) with prolonged tourniquet time has the potential to trigger ischemia-reperfusion injury, which can adversely affect knee function. Studies suggest that the magnitude of injury is less if it occurs following an ischemic event which takes place in another part of the body, known as ischemic preconditioning (IPC). The purpose of this study was to investigate the impact of oxidative stress on muscle injury and knee function and to elucidate if potential IPC effect can attenuate ischemia-reperfusion injury metabolites and prevent poor functional outcomes in single-stage bilateral TKA.
Methods: Thirty patients who underwent single-stage bilateral TKA under tourniquet were enrolled in the study. All procedures were initiated from the right limb. Upon completion of the procedure, the left tourniquet was inflated 20 minutes after the first tourniquet was deflated. The tourniquet time was noted. Pre- and postoperative levels of malondialdehyde (MDH), creatine kinase (CK), and lactate dehydrogenase (LDH) were evaluated. Knee function was assessed postoperatively at 1 month using WOMAC score.
Results: Postoperative levels of MDH, CK, and LDH were significantly increased in both extremities compared to preoperative levels. Serum MDH, CK, and LDH levels were not found to be correlated with tourniquet time for either extremity. Compared to the left extremity, the right extremity revealed increased postoperative oxidative stress, which was indicated by elevated serum MDH, CK, and LDH levels. Although tourniquet time and postoperative serum MDH, CK, and LDH levels were not found to be correlated with WOMAC index in either knee, the average change in WOMAC score at 1 month postoperatively was found to be higher in the left knee compared to the right.
Conclusion: The biochemical and functional outcomes can be attributed to potential IPC effect. During bilateral TKA, a 20-minute interval between tourniquets can create IPC effect and attenuate the magnitude of ischemia-reperfusion injury, preserving better functional outcomes.

Keywords

• Bilateral total knee arthroplasty
• ischemia-reperfusion injury
• ischemic precondition effect
• tourniquet

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