Tatani Irini, Kalaitzopoulou Electra, Skipitari Marianna, Ntoukas Aristeidis, Tsaliki Eleni A, Giakoumakis Savvas, Lakoumentas John, Varemmenou Athina, Michail Effimia, Papadea Polyxeni, Georgiou Christos D, Panagiotopoulos Elias
Department of Orthopaedics, Patras University Hospital, Patras 26504, Greece.
Department of Biology, University of Patras, Patras 26504, Greece.
SICOT J. 2025;11:47. doi: 10.1051/sicotj/2025042. Epub 2025 Aug 8.
Tourniquet use in total knee arthroplasty (TKA) can cause ischaemia-reperfusion (I-R) injury via oxidative stress. This study evaluated whether combined administration of the antioxidant N-acetylcysteine (NAC) and the iron-chelator Deferiprone can mitigate oxidative damage and improve clinical outcomes.
Twenty TKA patients were randomized into two groups, one group receiving NAC (600 mg, 6 h pre-op) and Deferiprone (1000 mg, 2 h pre-op) (intervention group) and the other group serving as placebo (control). Lipid hydroperoxides (LOOH) and protein malondialdehyde (PrMDA) were measured from quadriceps muscle tissue samples at 5 min (T1) and 40 min (T2) after tourniquet inflation, and 5 min after deflation (T3). Blood markers including serum ferritin, white blood cell (WBC) count, and polymorphonuclear neutrophils (PMNs) were assessed along with tissue PrMDA and LOOH as primary outcome measurements, while pain scores and knee flexion were recorded postoperatively as secondary outcome measurements.
LOOH levels were significantly lower in the intervention group at T2 and T3. PrMDA levels showed no significant differences. Ferritin levels rose by 69% in controls vs. 18% in the intervention group. WBC and PMNs normalized faster, with reduced pain and improved range of motion in the intervention group.
The attenuation of LOOH elevation, the faster PMN deactivation, the inhibition of ferritin release from the cells along with the improved clinical outcomes suggest that combined NAC and Deferiprone administration may reduce tourniquet-related oxidative stress and inflammation, enhancing early recovery in TKA patients.
全膝关节置换术（TKA）中使用止血带可通过氧化应激导致缺血再灌注（I-R）损伤。本研究评估了抗氧化剂N-乙酰半胱氨酸（NAC）和铁螯合剂去铁酮联合使用是否能减轻氧化损伤并改善临床结局。
20例TKA患者被随机分为两组，一组接受NAC（600mg，术前6小时）和去铁酮（1000mg，术前2小时）（干预组），另一组作为安慰剂（对照组）。在止血带充气后5分钟（T1）、40分钟（T2）和放气后5分钟（T3），从股四头肌组织样本中测量脂质过氧化氢（LOOH）和蛋白质丙二醛（PrMDA）。评估包括血清铁蛋白、白细胞（WBC）计数和多形核中性粒细胞（PMN）在内的血液标志物，以及组织PrMDA和LOOH作为主要结局指标，术后记录疼痛评分和膝关节屈曲度作为次要结局指标。
干预组在T2和T3时LOOH水平显著降低。PrMDA水平无显著差异。对照组铁蛋白水平升高69%，而干预组升高18%。干预组WBC和PMN恢复正常更快，疼痛减轻，活动范围改善。
LOOH升高的减轻、PMN更快失活、细胞中铁蛋白释放的抑制以及临床结局的改善表明，联合使用NAC和去铁酮可能减少止血带相关的氧化应激和炎症，促进TKA患者的早期恢复。
