Abstract
Early infections and wound healing disorders after implantation of a total knee replacement occur regardless of the intraoperative use of a tourniquet. The biochemical regulatory processes responsible for the disturbances in microcirculation and thus the potential therapeutic options have yet to be elucidated. The hypothesis of the present paper was that endothelin‐1 (ET‐1), a mediator of microcirculation disturbances in parenchymatous organs, also is released after major operations on peripheral joints.
The concentration of ET‐1 in the plasma was determined preoperatively and at 10 postoperative time points (5 min–48h) with (group A, n = 10) and without the use of a tourniquet (group B, n = 10). The ET‐1 concentration achieved its maximum 6h after opening the tourniquet, which corresponded to 3.3 times the preoperative value. Without a tourniquet, the concentration maximum (2.9 times the baseline value) was achieved already 1.5 h after the end of the operation. However, the total amount of ET‐1 secreted over 24 h was identical in both groups (p > 0.5).
We conclude that the tissue hypoxia resulting from the use of a tourniquet modulates ET‐1 secretion, but that traumatization during the operation has a much stronger influence on the total amount secreted.
ET‐1 antagonists thus should be discussed for the drug prophylaxis of wound healing disorders, regardless of the use of a tourniquet. © 2004 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved.