Use of tourniquet does not increase serum concentration of inflammatory mark-ers following total knee arthroplasty during the first 24 postoperative hours.

BACKGROUND: The literature on the systemic inflammatory reaction following tourniquet-induced ischemia and reperfusion in elective orthopedic surgery is limited. METHODS: This prospective comparative study compared the levels of clinically relevant cytokines and peripheral blood counts and major complications in patients undergoing total knee arthroplasty (TKA) with or without a tourniquet during the first postoperative day. Forty-three patients undergoing primary TKA for degenerative osteoarthritis were divided into two groups; 21 patients were operated on using (TG group) and 22 (NTG group) without using a tourniquet. Proinflammatory cytokines interleukin-1b, interleukin-6, anti-inflammatory cytokine interleukin-10, intercellular and vascular adhesion molecules, C-reactive protein, and full blood count were evaluated preoperatively and at one, three, six, and 24 hours postoperatively in both groups. RESULTS: Demographics, American Society of Anesthesiologists score, surgery duration, osteoarthritis grade, and other preoperative variable values were comparable between groups. The average tourniquet time was 67.8 minutes. The majority of testing variables did not demonstrate significant postoperative differences between groups. However, the mean IL-6 value was non-significantly higher for the TG than the NTG group during the first six postoperative hours. It demonstrated a trend to significance at the end of the first postoperative day. The mean hemoglobin and hematocrit levels were significantly higher for the NTG group at the sixth postoperative hour. CONCLUSIONS: The tourniquet use may affect the systemic inflammatory response. Patients undergoing TKA with or without a tourniquet demonstrated a similar systemic inflammatory response. However, reperfusion following approximately 70 minutes of tourniquet ischemia is a safe practice. HIPPOKRATIA 2021, 25 (1):31-37.

Interobserver and intraobserver reliability of Salter-Harris classification of physeal injuries.

BACKGROUND: Prognostic value of Salter-Harris (SH) classification is well established. Its reliability, however, can be questioned. We aim to evaluate the interobserver and intraobserver reliability of SH classification and to correlate the level of rater's experience with the correct scoring for each SH subclass. METHODS: Twenty-eight independent raters stratified in three levels of seniority evaluated 50 randomly selected radiographs of physeal injuries. The interval for intraobserver reliability was 12 weeks. The overall agreement between raters was assessed using kappa statistics. Student's t-test and Spearman correlation coefficient used to compare results between groups. RESULTS: Overall kappa for interobserver reliability was 0.45. The mean kappa difference between specialists and residents was significant (p <0.001). The mean kappa difference was also significant between senior and junior residents (p <0.001), favoring senior residents. Intraobserver kappa differs between specialists (0.55) and residents (0.49), but this did not reach statistical significance (p =0.34). SH type II and III demonstrated the highest category-specific kappa coefficient. Seniority was correlated significantly with the number of correct answers (Spearman rho =0.6 p =0.001). CONCLUSIONS: Moderate interobserver reliability that was improved with greater rater's experience was found. Type II and III are the best scored regardless rater's experience. Type I, IV, and V when in doubt, require additional imaging. Hippokratia 2016, 20(3): 222-226.