Table 4.
Effects of ischemic preconditioning (IPC) and remote IPC (rIPC) on TQ-induced I/R injury in TKA.
| Study model/specimen/TQ pressure | IPC protocol/TQ ischemia time/sample size/age | Main findings (compared to control) | Interpretation | References | ||
|---|---|---|---|---|---|---|
| Intervention | Control | Clinical outcome | Mechanism | |||
| RCT/antecubital venous blood, quadriceps muscle biopsy, SBP + 100 mmHg | 3 cycles of 5 min ischemia and 5 min reperfusion at operated thigh, 68–87 min, n = 10 | no IPC, 68–87 min, n = 10 | N/A | ↑ gene expression (i) immediate early response genes (ii) oxidative stress defense genes (iii) mitochondrial genes (iv) prosurvival genes ↓ gene expression (i) proapoptotic genes ↔ serum IL-6, CRP, ESR, and WBC count |
IPC induced a protective genomic response IPC did not prevent systemic inflammatory response |
[37] |
| Case-control study/quadriceps muscle biopsy | N/A, n = 4 | No IPC, n = 4 | N/A | Altered expression of genes involved in neurological system process and regulation of neuron apoptosis | IPC induced a protective genomic response | [38] |
| RCT/venous blood, urine/250 mmHg | 1 cycle of 5 min ischemia and 5 min reperfusion at operated thigh, 58 ± 11 min, n = 17, 67 ± 11 yr | no IPC, 52 ± 11 min, n = 17, 67 ± 10 yr | ↓ median pain scores within 48 h after surgery ↔ postoperative analgesic consumption ↓ length of hospital stay |
↔ serum IL-6, TNF-α, CRP, and WBC count ↔ urine desmosine/Cr ratio |
IPC did not prevent systemic inflammatory response or the level of lung injury IPC may improve postoperative pain control |
[33] |
| RCT/venous blood, blood from surgical drain/250 mmHg | 1 cycle of 5 min ischemia and 5 min reperfusion at operated thigh, 48 min (IQR 13), n = 30, 67 yr (IQR 10.8) | no IPC, 54 min (IQR 18), n = 30, 72.5 yr (IQR 13) | ↓ pain scores within 48 h after surgery ↔ postoperative analgesic consumption ↔ physical therapy parameters ↔ length of hospital stay |
↔ intraarticular IL-6, TNF-α ↔ systemic prothrombotic levels |
IPC may improve postoperative pain control Hypercoagulative state occurred after TKA surgery using TQ application |
[39] |
| RCT/arterial blood, venous blood/double SBP mmHg | 3 cycles of 5 min ischemia at nonoperated thigh, n = 36, 69 ± 7 yr | No IPC, n = 36, 71 ± 7 yr | Brain: ↑ rScO2 ↔ POCD at 1 week Lungs: ↑ PF ratio |
↓ serum LDH ↔ serum CPK and AST ↔ serum IL-6, TNF-α, IL-10, and TNF-β |
Remote IPC improved regional cerebral and pulmonary oxygenation possibly via a decrease in tissue damage | [32] |
| Cross-sectional study/venous blood/double SBP mmHg | Approx. 60 min ischemia at previously operated thigh, 62 ± 19 min, n = 12, 67 ± 5 yr | First-operated knee, 63 ± 14 min, n = 12, 67 ± 5 yr | N/A | Tend to ↓ whole blood ROS production ↔ plasma PCOOH |
Remote IPC may occur during bilateral TKA with sequential application of TQ | [42] |
| Cross-sectional study/venous blood | Approx. 90 min ischemia at previously operated thigh, 89 ± 9 min, n = 16, 70 ± 4 yr | First-operated knee, 91 ± 11 min, n = 16, 70 ± 4 yr | N/A | Tend to ↓ serum MDA | Remote IPC may occur during bilateral TKA with sequential application of TQ | [31] |
| Cross-sectional study/venous blood (dorsum of each foot)/double SBP mmHg | Approx. 60 min ischemia at previously operated thigh with 20 min reperfusion, 62 ± 19 min, n = 30, 64 ± 5 yr | First-operated knee (right), 61 ± 5 min, n = 30, 64 ± 5 yr | Muscle: ↔ WOMAC scores (assessment of joint pain, stiffness, and function) at 1 month |
↔ serum MDA ↔ serum LDH |
Sequential ischemic surgical procedure did not reduce oxidative injury after reperfusion | [43] |
AST: aspartate aminotransferase; CPK: creatinine phosphokinase; CRP: c-reactive protein; Cr: creatinine; IL: interleukin; ESR: erythrocyte sedimentation rate; IPC: ischemic preconditioning; I/R: ischemia and reperfusion; IQR: interquantile range; LDH: lactate dehydrogenase; MDA: malondialdehyde; N/A: not available; PCOOH: phosphatidylcholine hydroperoxide; PF ratio: ratio of arterial oxygen partial pressure to fractional inspired oxygen; POCD: postoperative cognitive dysfunction; RCT: randomized controlled trial; ROS: reactive oxygen species; rScO2: regional cerebral oxygen saturation; SBP: systolic blood pressure; TKA: total knee arthroplasty; TNF: tumor necrosis factor; TQ: tourniquet; WBC: white blood cell; WOMAC: Western Ontario and McMaster University Osteoarthritis Index.