Analysis of influencing factors of muscular calf vein thrombosis after hip and knee arthroplasty_West China Medical Journal

Authors：

GU Siqi ¹ , LI Jiahui ² , SONG Mi ¹ , LI Xiaofang ¹ , KONG Dan ² , CHEN Yu’e ² ,  GAO Yuan ³

1. Medical School of Chinese PLA, Beijing 100853, P. R. China;
2. Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, P. R. China;
3. Department of Nursing, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, P. R. China;

Corresponding?author：

GAO Yuan, Email: gaoyuanzd@163.com

Keywords：

Muscular calf vein thrombosis; total joint arthroplasty; early ambulation; drainage

DOI：

10.7507/1002-0179.202207062

Video：

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Objective To explore the influencing factors of muscle calf vein thrombosis (MCVT) after hip and knee arthroplasty. Methods Convenience sampling method was used to select patients who underwent hip or knee arthroplasty in 4 hospitals in Beijing, Jiangsu and Hainan between March 2021 and May 2022 as the research subjects. They were divided into MCVT group and non-MCVT group according to whether the lower limb MCVT occurred on the 3rd postoperative day. Generalized linear mixed model was used to analyze the influencing factors of MCVT. Results A total of 278 patients were included, including 47 patients in the MCVT group, accounting for 16.91%, and 231 patients in the non-MCVT group, accounting for 83.09%. Generalized linear mixed model analysis showed that the ambulation on the first postoperative day [odds ratio=0.364, 95% confidence interval (0.159, 0.832), P=0.017] and preoperative activated partial thromboplastin time [odds ratio=0.884, 95% confidence interval (0.785, 0.994), P=0.040] were protective factors for MCVT after hip and knee arthroplasty. Conclusions The ambulation on the first postoperative day and preoperative activated partial thromboplastin time are protective factors for MCVT after hip and knee arthroplasty. The relationship between hypertension, drainage and MCVT needs to be further explored. Clinical medical staff should pay close attention to the postoperative ambulation of patients undergoing hip and knee arthroplasty, encourage and guide patients to get out of bed early, comprehensively assess the patients’ condition and the risk of postoperative MCVT, and flexibly formulate individualized prevention and treatment plans to avoid the occurrence of MCVT and improve the prognosis.

Citation： GU Siqi, LI Jiahui, SONG Mi, LI Xiaofang, KONG Dan, CHEN Yu’e, GAO Yuan. Analysis of influencing factors of muscular calf vein thrombosis after hip and knee arthroplasty. West China Medical Journal, 2022, 37(10): 1497-1502. doi: 10.7507/1002-0179.202207062 Copy

1.	Kargin D, ?ncesoy MA, Ona? O, et al. The effect of previous hip surgery on the outcome of hip arthroplasty in young patients. J Arthroplasty, 2018, 33(9): 2890-2892.
2.	Manfredi VM, Machado MB, Barbato NG, et al. Effectiveness of deep venous thrombosis prevention in total hip arthroplasty. Acta Ortop Bras, 2021, 29(6): 293-296.
3.	Runner RP, Gottschalk MB, Staley CA, et al. Utilization patterns, efficacy, and complications of venous thromboembolism prophylaxis strategies in primary hip and knee arthroplasty as reported by American Board of Orthopedic Surgery Part II Candidates. J Arthroplasty, 2019, 34(4): 729-734.
4.	Heller T, Becher M, Kr?ger JC, et al. Isolated calf deep venous thrombosis: frequency on venous ultrasound and clinical characteristics. BMC Emerg Med, 2021, 21(1): 126.
5.	Qiu T, Zhang T, Liu L, et al. The anatomic distribution and pulmonary embolism complications of hospital-acquired lower extremity deep venous thrombosis. J Vasc Surg Venous Lymphat Disord, 2021, 9(6): 1391-1398.e3.
6.	龔恒, 黃斌, 付立功, 等. 全膝關節置換術后小腿肌間靜脈血栓臨床研究. 中國運動醫學雜志, 2020, 39(11): 863-869.
7.	Kuczmik W, Wysokinski WE, Hesley GK, et al. Calf vein thrombosis comparison of outcomes for axial and muscular venous thrombosis. Thromb Haemost, 2021, 121(2): 216-223.
8.	王劍鋒. 人工膝關節置換術圍手術期肌間靜脈血栓的轉歸及其影響因素的分析. 西安: 西安醫學院, 2021.
9.	張源, 吉忠杰, 張天華, 等. 小腿肌間靜脈血栓危險因素及其臨床防治的進展. 中國醫師進修雜志, 2022, 45(3): 279-284.
10.	楊猛, 江旭, 曹福洋, 等. 單側全膝關節置換術后下肢肌間靜脈血栓形成因素分析及預防. 中華創傷骨科雜志, 2022, 24(2): 155-160.
11.	孫江麗, 張巖, 李虎. 彩色多普勒超聲診斷全膝關節置換圍手術期下肢深靜脈血栓形成的臨床價值. 中華醫學超聲雜志(電子版), 2019, 16(9): 691-696.
12.	Caprini JA. Risk assessment as a guide to thrombosis prophylaxis. Curr Opin Pulm Med, 2010, 16(5): 448-452.
13.	中華醫學會骨科學分會. 中國骨科大手術靜脈血栓栓塞癥預防指南. 中華骨科雜志, 2016(2): 65-71.
14.	李俊來, 曹曉林, 余美琴, 等. 提高彩色多普勒超聲診斷下肢深靜脈血栓效率的策略研究. 中華醫學超聲雜志(電子版), 2013, 10(2): 134-138.
15.	Samama CM, Afshari A, ESA VTE Guidelines Task Force. European guidelines on perioperative venous thromboembolism prophylaxis. Eur J Anaesthesiol, 2018, 35(2): 73-76.
16.	周宗科, 翁習生, 曲鐵兵, 等. 中國髖、膝關節置換術加速康復—圍術期管理策略專家共識. 中華骨與關節外科雜志, 2016, 9(1): 1-9.
17.	Pearse EO, Caldwell BF, Lockwood RJ, et al. Early mobilisation after conventional knee replacement may reduce the risk of postoperative venous thromboembolism. J Bone Joint Surg Br, 2007, 89(3): 316-22.
18.	谷思琪, 皮紅英, 宋咪, 等. 機械預防深靜脈血栓形成的機制及應用研究綜述. 解放軍醫學院學報, 2021, 42(12): 1326-1329.
19.	陳瓊. 常熟市全髖關節置換患者術后早期康復的現狀及影響因素分析. 蘇州: 蘇州大學, 2018.
20.	Chua MJ, Hart AJ, Mittal R, et al. Early mobilisation after total hip or knee arthroplasty: a multicentre prospective observational study. PLoS One, 2017, 12(6): e0179820.
21.	向娜, 馬玉芬, 高娜, 等. 加速康復外科理念下全膝關節置換患者術后早期下床活動現狀調查. 中國護理管理, 2018, 18(11): 1544-1549.
22.	White RH, Henderson MC. Risk factors for venous thromboembolism after total hip and knee replacement surgery. Curr Opin Pulm Med, 2002, 8(5): 365-371.
23.	Zeng Y, Si H, Wu Y, et al. The incidence of symptomatic in-hospital VTEs in Asian patients undergoing joint arthroplasty was low: a prospective, multicenter, 17, 660-patient-enrolled cohort study. Knee Surg Sports Traumatol Arthrosc, 2019, 27(4): 1075-1082.
24.	Mahmoodi BK, Cushman M, Anne N?ss I, et al. Association of traditional cardiovascular risk factors with venous thromboembolism: an individual participant data meta-analysis of prospective studies. Circulation, 2017, 135(1): 7-16.
25.	Nazarzadeh M, Pinho-Gomes AC, Mohseni H, et al. Blood pressure and risk of venous thromboembolism: a large-scale prospective cohort analysis and a mendelian randomisation study. J Hypertens, 2019, 37: e95.
26.	姚杰, 孟盡海, 王文娟, 等. 骨科手術病人術后下肢深靜脈血栓形成的危險因素. 中華麻醉學雜志, 2013, 33(4): 413-416.
27.	Kim YH, Cho SH, Kim RS. Drainage versus nondrainage in simultaneous bilateral total knee arthroplasties. Clin Orthop Relat Res, 1998(347): 188-193.
28.	Ayan NRS, Akal?n Y, ?evik N, et al. Does not use of closed suction drainage in total knee arthroplasty with tranexamic acid reduce blood loss?. Ortop Traumatol Rehabil, 2020, 22(5): 339-346.
29.	Bartosz P, Marczyński W, Para M, et al. Comparative study of suction drainage placement in cementless hip replacement among patients undergoing extended thromboprophylaxis: a prospective randomized study. BMC Musculoskelet Disord, 2021, 22(1): 688.

1. Kargin D, ?ncesoy MA, Ona? O, et al. The effect of previous hip surgery on the outcome of hip arthroplasty in young patients. J Arthroplasty, 2018, 33(9): 2890-2892.
2. Manfredi VM, Machado MB, Barbato NG, et al. Effectiveness of deep venous thrombosis prevention in total hip arthroplasty. Acta Ortop Bras, 2021, 29(6): 293-296.
3. Runner RP, Gottschalk MB, Staley CA, et al. Utilization patterns, efficacy, and complications of venous thromboembolism prophylaxis strategies in primary hip and knee arthroplasty as reported by American Board of Orthopedic Surgery Part II Candidates. J Arthroplasty, 2019, 34(4): 729-734.
4. Heller T, Becher M, Kr?ger JC, et al. Isolated calf deep venous thrombosis: frequency on venous ultrasound and clinical characteristics. BMC Emerg Med, 2021, 21(1): 126.
5. Qiu T, Zhang T, Liu L, et al. The anatomic distribution and pulmonary embolism complications of hospital-acquired lower extremity deep venous thrombosis. J Vasc Surg Venous Lymphat Disord, 2021, 9(6): 1391-1398.e3.
6. 龔恒, 黃斌, 付立功, 等. 全膝關節置換術后小腿肌間靜脈血栓臨床研究. 中國運動醫學雜志, 2020, 39(11): 863-869.
7. Kuczmik W, Wysokinski WE, Hesley GK, et al. Calf vein thrombosis comparison of outcomes for axial and muscular venous thrombosis. Thromb Haemost, 2021, 121(2): 216-223.
8. 王劍鋒. 人工膝關節置換術圍手術期肌間靜脈血栓的轉歸及其影響因素的分析. 西安: 西安醫學院, 2021.
9. 張源, 吉忠杰, 張天華, 等. 小腿肌間靜脈血栓危險因素及其臨床防治的進展. 中國醫師進修雜志, 2022, 45(3): 279-284.
10. 楊猛, 江旭, 曹福洋, 等. 單側全膝關節置換術后下肢肌間靜脈血栓形成因素分析及預防. 中華創傷骨科雜志, 2022, 24(2): 155-160.
11. 孫江麗, 張巖, 李虎. 彩色多普勒超聲診斷全膝關節置換圍手術期下肢深靜脈血栓形成的臨床價值. 中華醫學超聲雜志(電子版), 2019, 16(9): 691-696.
12. Caprini JA. Risk assessment as a guide to thrombosis prophylaxis. Curr Opin Pulm Med, 2010, 16(5): 448-452.
13. 中華醫學會骨科學分會. 中國骨科大手術靜脈血栓栓塞癥預防指南. 中華骨科雜志, 2016(2): 65-71.
14. 李俊來, 曹曉林, 余美琴, 等. 提高彩色多普勒超聲診斷下肢深靜脈血栓效率的策略研究. 中華醫學超聲雜志(電子版), 2013, 10(2): 134-138.
15. Samama CM, Afshari A, ESA VTE Guidelines Task Force. European guidelines on perioperative venous thromboembolism prophylaxis. Eur J Anaesthesiol, 2018, 35(2): 73-76.
16. 周宗科, 翁習生, 曲鐵兵, 等. 中國髖、膝關節置換術加速康復—圍術期管理策略專家共識. 中華骨與關節外科雜志, 2016, 9(1): 1-9.
17. Pearse EO, Caldwell BF, Lockwood RJ, et al. Early mobilisation after conventional knee replacement may reduce the risk of postoperative venous thromboembolism. J Bone Joint Surg Br, 2007, 89(3): 316-22.
18. 谷思琪, 皮紅英, 宋咪, 等. 機械預防深靜脈血栓形成的機制及應用研究綜述. 解放軍醫學院學報, 2021, 42(12): 1326-1329.
19. 陳瓊. 常熟市全髖關節置換患者術后早期康復的現狀及影響因素分析. 蘇州: 蘇州大學, 2018.
20. Chua MJ, Hart AJ, Mittal R, et al. Early mobilisation after total hip or knee arthroplasty: a multicentre prospective observational study. PLoS One, 2017, 12(6): e0179820.
21. 向娜, 馬玉芬, 高娜, 等. 加速康復外科理念下全膝關節置換患者術后早期下床活動現狀調查. 中國護理管理, 2018, 18(11): 1544-1549.
22. White RH, Henderson MC. Risk factors for venous thromboembolism after total hip and knee replacement surgery. Curr Opin Pulm Med, 2002, 8(5): 365-371.
23. Zeng Y, Si H, Wu Y, et al. The incidence of symptomatic in-hospital VTEs in Asian patients undergoing joint arthroplasty was low: a prospective, multicenter, 17, 660-patient-enrolled cohort study. Knee Surg Sports Traumatol Arthrosc, 2019, 27(4): 1075-1082.
24. Mahmoodi BK, Cushman M, Anne N?ss I, et al. Association of traditional cardiovascular risk factors with venous thromboembolism: an individual participant data meta-analysis of prospective studies. Circulation, 2017, 135(1): 7-16.
25. Nazarzadeh M, Pinho-Gomes AC, Mohseni H, et al. Blood pressure and risk of venous thromboembolism: a large-scale prospective cohort analysis and a mendelian randomisation study. J Hypertens, 2019, 37: e95.
26. 姚杰, 孟盡海, 王文娟, 等. 骨科手術病人術后下肢深靜脈血栓形成的危險因素. 中華麻醉學雜志, 2013, 33(4): 413-416.
27. Kim YH, Cho SH, Kim RS. Drainage versus nondrainage in simultaneous bilateral total knee arthroplasties. Clin Orthop Relat Res, 1998(347): 188-193.
28. Ayan NRS, Akal?n Y, ?evik N, et al. Does not use of closed suction drainage in total knee arthroplasty with tranexamic acid reduce blood loss?. Ortop Traumatol Rehabil, 2020, 22(5): 339-346.
29. Bartosz P, Marczyński W, Para M, et al. Comparative study of suction drainage placement in cementless hip replacement among patients undergoing extended thromboprophylaxis: a prospective randomized study. BMC Musculoskelet Disord, 2021, 22(1): 688.

West China Medical Journal

Analysis of influencing factors of muscular calf vein thrombosis after hip and knee arthroplasty

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