ObjectiveTo explore the correlation between the Barthel index score and other factors with the preoperative occurrence of deep vein thrombosis (DVT) in patients undergoing total hip arthroplasty (THA) revision surgery. MethodsA retrospective analysis was conducted on clinical data from 122 patients who met the inclusion criteria and underwent THA revision surgery between April 2017 and November 2020. Among them, 61 were male and 61 were female, with an age range of 32-85 years (mean, 65.3 years). The reasons for revision included prosthetic joint infection in 7 cases, periprosthetic fracture in 4 cases, prosthetic dislocation in 6 cases, and aseptic loosening in 105 cases. The Barthel index score was 76.4±17.7, with 10 cases classified as level 1, 57 as level 2, 37 as level 3, and 18 as level 4. Univariate analysis was performed on variables such as age, gender, body mass index, Barthel index score, preoperative D-dimer positivity, history of diabetes, hypertension, cancer, cerebral infarction, smoking, and thrombosis in patients with and without preoperative DVT. Furthermore, logistic regression was used to identify risk factors for preoperative DVT in THA revision surgery. The incidence of preoperative DVT was compared among different Barthel index score groups. ResultsPreoperative DVT was detected in 11 patients (9.02%), all of whom had intermuscular venous thrombosis. Among them, 1 had prosthetic joint infection, 1 had periprosthetic fracture, 1 had prosthetic dislocation, and 8 had aseptic loosening. Univariate analysis showed significant differences between the two groups in terms of age, gender, and Barthel index score (P<0.05). logistic regression further revealed that female, age ≥70 years, and Barthel index score<60 were independent risk factors for preoperative DVT in patients undergoing THA revision surgery (P<0.05). The incidence of preoperative DVT in patients with Barthel index scores of levels 1, 2, 3, and 4 were 0 case (0%), 2 cases (3.5%), 3 cases (8.1%), and 6 cases (33.3%), respectively. A significant correlation was found between Barthel index score classification and the incidence of preoperative DVT in patients undergoing THA revision surgery (χ2=10.843, P=0.001). ConclusionIn patients undergoing THA revision surgery, older age, female, and lower Barthel index scores are associated with higher preoperative DVT incidence. For patients with low preoperative Barthel index scores, preoperative thrombosis screening should be emphasized.
Objective To explore the predictive value of the pre-injury Barthel index (BI) for 1-year postoperative case fatality rate after hip arthroplasty in elderly patients with hip fracture, and to determine its optimal cut-off value. Methods A retrospective cohort study was conducted. Elderly patients with hip fracture who underwent hip arthroplasty and met the selection criteria between January 1, 2020 and December 31, 2022 were enrolled. General baseline data [age, gender, body mass index (BMI), comorbidities including diabetes and hypertension, medical history including malignancy and thrombosis, and smoking history], clinical indicators (preoperative hemoglobin level, operation duration, postoperative venous thrombosis), pre-admission and pre-injury BI, as well as 1-year postoperative survival outcomes were collected. logistic regression analysis was used to identify risk factors for 1-year postoperative fatality, and receiver operating characteristic curve analysis was performed to determine the optimal cut-off value of pre-injury BI for predicting postoperative fatality. Results A total of 584 patients were enrolled, including 182 males and 402 females, with a mean age of 78.6 years (range, 65-99 years). Sixty-one patients died within 1 year after operation, with a 1-year postoperative case fatality rate of 10.45%. logistic regression analysis showed that age was an independent risk factor for 1-year postoperative fatality (OR=1.138, P=0.002), while pre-injury BI was an independent protective factor (OR=0.972, P=0.008). BMI, preoperative hemoglobin level, and operation duration had no independent predictive significance (P>0.05). The area under the curve of pre-injury BI for predicting 1-year postoperative fatality was 0.794 (95%CI: 0.754, 0.835; P<0.001), with a sensitivity of 0.61, a specificity of 0.98, and the optimal cut-off value of 80. According to the cut-off value, there were 263 patients with pre-injury BI≤80 and 321 patients with pre-injury BI>80. The 1-year postoperative case fatality rates of the two groups were 22.81% and 0.31%, respectively, and the difference was significant (χ2=78.251, P<0.001). Conclusion Pre-injury BI is a reliable predictive factor for 1-year postoperative fatality after hip arthroplasty in elderly patients with hip fracture. It is recommended that pre-injury BI assessment should be included in routine admission evaluation. For patients with pre-injury BI<80, intensified management and multidisciplinary intervention should be implemented to improve postoperative prognosis.
