The relationship between tourniquet duration and Il-6, d-dimer and visual analogue scale in Total knee arthroplasty

Background: The use of tourniquet during TKA aside from having several advantages, is also accompanied by several risks. This study was performed to prove the relation between the duration of tourniquet application to inflammatory response, pro-thrombotic condition, and pain response of the patients undergoing TKA procedures. Methods: This study is a cross-sectional analytical experimental research. A femoral tourniquet was applied to 34 primary osteoarthritis (OA) patients undergoing the standard procedure of TKA and the duration of tourniquet application data was noted and collected. Pain assessment was performed by using Visual Analogue Scale (VAS), whereas blood samples are taken from the patients and IL-6 cytokine and D-dimer levels were identified at 12 hours and 24 hours post-operatively. Statistical analysis (Pearson correlation) was performed to see the correlation of tourniquet duration to the VAS, IL-6, and D-dimer serum level at 12 hours and 24 hours post-operatively. Results: The result of this study showed a positive correlation between the duration of tourniquet use with IL-6 at 12 hours post operation (r=0.359) and 24 hours post operation (r=0.658); with D-dimer at 12 hours post operation (r=0.491) and 24 hours post operation (r=0.483); and with VAS at 12 hours post operation (r=0.647) and 24 hours post operation (r=0.507) with p<0,05. A positive correlation was found between tourniquet time and IL-6, D-dimer and VAS. Conclusions: The duration of tourniquet cut-off time of more than 122.5 minutes elevates IL-6 and D-Dimer which increases the risk for SIRS and DVT.