Characterizing tourniquet induced hemodynamics during total knee arthroplasty using diffuse optical spectroscopy.

Autor: Philipopoulos GP; Beckman Laser Institute and Medical Clinic, Laser Microbeam and Medical Program, University of California Irvine, Irvine, California, USA., Sharareh B; Department of Orthopaedics and Sport Medicine, University of Washington, Seattle, Washington, USA., Ganesan G; Beckman Laser Institute and Medical Clinic, Laser Microbeam and Medical Program, University of California Irvine, Irvine, California, USA.; Institute for Clinical and Translation Science, University of California Irvine, Irvine, California, USA., Tromberg BJ; Beckman Laser Institute and Medical Clinic, Laser Microbeam and Medical Program, University of California Irvine, Irvine, California, USA., O'Sullivan TD; Department of Electrical Engineering, University of Notre Dame, Notre Dame, Indiana, USA., Schwarzkopf R; NYU Langone Orthopaedic Hospital, Hospital for Joint Diseases, New York, New York, USA.
Jazyk: angličtina
Zdroj: Journal of orthopaedic research : official publication of the Orthopaedic Research Society [J Orthop Res] 2023 Jan; Vol. 41 (1), pp. 104-114. Date of Electronic Publication: 2022 Mar 25.
DOI: 10.1002/jor.25327
Abstrakt: Tourniquet use creates a reduced blood surgical field during total knee arthroplasty (TKA), however, prolonged ischemia may cause postoperative tourniquet complications. To understand the effects of tourniquet-induced ischemia, we performed a prospective observational study using quantitative broadband diffuse optical spectroscopy (DOS) to measure tissue hemodynamics and water and lipid concentrations before, during, and after tourniquet placement in subjects undergoing TKA. Data was collected for 6 months and, of the total subjects analyzed (n = 24), 22 were primary TKAs and 2 were revision TKA cases. We specifically investigated tourniquet-induced hemodynamics based upon subject-specific tissue composition and observed a significant relationship between the linear rate of deoxygenation after tourniquet inflation and water/lipid ratio (W/L, p < 0.0001) and baseline somatic tissue oxygen saturation, StO 2 (p = 0.05). Subjects with a low W/L ratio exhibited a lower tissue metabolic rate of oxygen consumption, (tMRO 2 ) (p = 0.008). Changes in deoxyhemoglobin [HbR] (p = 0.009) and lipid fraction (p = 0.001) were significantly different between high and low W/L subject groups during deoxygenation. No significant differences were observed for hemodynamics during reperfusion and total tourniquet time was neither significantly related to the hemodynamic hyperemic response (p = 0.73) nor the time to max StO 2 after tourniquet release (p = 0.57). In conclusion, we demonstrate that DOS is capable of real-time monitoring of tissue hemodynamics distal to the tourniquet during TKA, and that tissue composition should be considered. DOS may help surgeons stratify hemodynamics based upon tissue composition and eventually aid the preoperative risk assessment of vascular occlusions from tourniquet use during TKA.
(© 2022 Orthopaedic Research Society. Published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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