Deep vein thrombosis distribution and risk factors after total knee arthroplasty during enhanced recovery after surgery

doi:10.12307/2023.292

Abstract

Abstract: BACKGROUND: Deep vein thrombosis is one of the common complications after total knee arthroplasty. In recent years, enhanced recovery after surgery has developed rapidly. However, there is still a lack of large sample studies on the occurrence and risk factors of thrombosis after total knee arthroplasty in China.
OBJECTIVE: To explore the occurrence of deep vein thrombosis in the lower extremities after total knee arthroplasty during enhanced recovery after surgery, and to further explore the risk factors for postoperative deep vein thrombosis.
METHODS: A total of 1 260 patients who underwent unilateral total knee arthroplasty for knee osteoarthritis in the First Affiliated Hospital of Soochow University from May 2016 to December 2021 were retrospectively analyzed. According to the results of postoperative venous ultrasound of the lower limbs, the patients were assigned into thrombosis group (n=140) and non-thrombosis group (n=1 120). The differences of various indicators between the two groups were compared by univariate analysis. Finally, the possible meaningful indicators were taken as independent variables into the binary multivariate logistic regression analysis.
RESULTS AND CONCLUSION: (1) 140 patients suffered from postoperative deep vein thrombosis, of which the incidence of proximal thrombosis was 1.67%, and the incidence of distal thrombosis was 9.44%. In the proximal type, 38.10% of the thrombus involved only one vein, and 61.90% of the patients involved two or more veins. Of the distal type, 79.83% involved a single vein and 20.17% involved two or more veins. (2) Univariate analysis results showed that the proportion of patients with a history of hypertension, a history of deep vein thrombosis and a history of drinking alcohol in the thrombotic group were significantly higher than those of the non-thrombosis group (P < 0.05). (3) Binary multivariate logistic regression analysis showed that a history of preoperative hypertension (OR=1.686, P=0.012, 95%CI=1.123-2.531), a history of deep vein thrombosis (OR=4.794, P < 0.001, 95%CI=2.124-10.820), and a history of alcohol consumption (OR=10.733, P < 0.001, 95%CI=6.942-16.594) were risk factors for the development of deep vein thrombosis after total knee arthroplasty. (4) The results show that although the incidence of proximal thrombosis is not high during the enhanced recovery after surgery, given that it often involves two or more veins, attention should be paid to the evaluation of thrombosis treatment in such patients. Preoperative history of hypertension, previous history of varicose veins, and the presence of alcohol consumption are independent risk factors for the development of deep vein thrombosis in the lower limbs after total knee arthroplasty, so surgeons should focus on the patient's general condition and perform preoperative optimization.

Key words: osteoarthritis, total knee arthroplasty, enhanced recovery after surgery, deep vein thrombosis, logistic regression analysis, risk factor

CLC Number:

Wu Qian, Liu Lingfeng, Li Lisong, Lu Yingjie, Zhou Liyu, Xu Wu, Huang Lixin, Jiang Dinghua. Deep vein thrombosis distribution and risk factors after total knee arthroplasty during enhanced recovery after surgery[J]. Chinese Journal of Tissue Engineering Research, 2023, 27(13): 2044-2050.

Figures/Tables 5

2.1 全膝关节置换后血栓发生情况全膝关节置换后血栓发生情况，见图2A。此次研究纳入的1 260例患者中，140例患者术后经双下肢静脉彩超诊断为深静脉血栓，总体血栓发生率为11.11%(140/1 260)。全膝关节置换后140例血栓组患者中各静脉累及情况，见图2B。各静脉累及比例从高到低依次为：肌间静脉80.00%(112/140)、胫后静脉25.71%(36/140)、腓静脉17.86%(25/140)、腘静脉12.86%(18/140)、股浅静脉2.14% (3/140)、胫前静脉1.43%(2/140)。全膝关节置换后累及静脉支数的频率情况，见图2C。140例术后发生血栓的患者中，103例患者术后血栓单纯累及单支静脉，占比73.57%(103/140)；22例患者术后血栓累及双支静脉，占比15.71%(22/140)；11例患者术后血栓累及3支静脉，占比7.86%(11/140)；4例患者术后血栓累及4支静脉，占比2.86%(4/140)。根据血栓累及部位，以腘静脉平面为界，若累及腘静脉及以上静脉则分组为近端型血栓组，包括腘静脉、股浅静脉、股深静脉、股总静脉、髂外静脉。若单纯累及腘静脉以下静脉则分组为远端型血栓组，包括肌间静脉、胫前静脉、胫后静脉及腓静脉。全膝关节置换后血栓分布情况，见图2D。140例术后发生血栓的患者中，21例形成了近端型血栓，发生率为1.67%(21/1 260)；119例形成了远端型血栓，发生率为9.44%(119/1 260)。全膝关节置换后21例近端型血栓累及静脉支数频率情况，见图2E。8例单纯累及单支静脉，占比38.10%(8/21)，包括腘静脉6例、股浅静脉2例。4例累及双支静脉，占比19.05%(4/21)，包括腘静脉+肌间静脉1例、腘静脉+胫后静脉2例、股浅静脉+胫后静脉1例。5例累及3支静脉，占比23.81%(5/21)，包括腘静脉+胫后静脉+肌间静脉1例、腘静脉+腓静脉+肌间静脉2例、腘静脉+胫后静脉+腓静脉1例、腘静脉+胫前静脉+腓静脉1例。4例累及4支静脉，占比19.05%(4/21)，均为腘静脉+胫后静脉+腓静脉+肌间静脉。全膝关节置换后119例远端型血栓中累及静脉支数频率情况，见图2F。 95例单纯累及单支静脉，占比79.83%(95/119)，包括单纯累及肌间静脉84例、胫后静脉6例、腓静脉5例。18例累及双支静脉，占比15.13%(18/119)，包括腓静脉＋肌间静脉2例、胫前静脉+肌间静脉1例、胫后静脉＋肌间静脉11例、胫后静脉＋腓静脉4例。6例累及三支静脉，占比5.04%(6/119)，均为胫后静脉＋腓静脉＋肌间静脉。 "

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