Chinese Journal of Tissue Engineering Research ›› 2022, Vol. 26 ›› Issue (15): 2330-2336.doi: 10.12307/2022.585

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Tuina prevents deep venous thrombosis of the lower limbs after total knee arthroplasty

Zhao Chi1, Xu Hui2, Kang Bingxin3, A Xinyu1, Xie Jun4, 5, Sun Songtao4, 5, Shen Jun4, 5, Xiao Lianbo4, 5, Shi Qi6, 7   

  1. 1Shanghai University of Traditional Chinese Medicine; 2Henan University of Chinese Medicine; 3The First Affiliated Hospital of Henan University of Chinese Medicine; 4Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine; 5Arthritis Research Institute of Integrated Traditional Chinese and Western Medicine; 6Longhua Hospital Affiliated to Shanghai University of Chinese Medicine; 7Institute of Spinal Diseases, Shanghai University of Chinese Medicine
  • Received:2021-08-17 Revised:2021-09-18 Accepted:2021-10-18 Online:2022-05-28 Published:2022-01-05
  • Contact: Xiao Lianbo, Master, Chief physician, Doctoral supervisor, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200050, China; Arthritis Research Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai 200050, China
  • About author:Zhao Chi, MD candidate, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
  • Supported by:
    Integrated Traditional Chinese and Western Medicine Rehabilitation, Diagnosis and Treatment Capacity Improvement Project of Shanghai Health and Family Planning Commission, No. ZY(2018-2020)-FWTX-6023 (to XLB); Shanghai Key Clinical Specialist Construction Project, No. shslczdzk04801 (to XLB); Shanghai Changning District Science and Technology Commission Project, No. CNKW2020Y23(to XJ); Shanghai University of Traditional Chinese Medicine’s Graduate Innovative Training Project, No. Y2021009 (to ZC)

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Abstract: BACKGROUND: With the update of artificial biomaterials and surgical techniques, total knee arthroplasty has become a reliable surgical method for the treatment of severe knee osteoarthritis. It can effectively relieve joint pain and stiffness, correct joint deformity, and restore joint function in patients with knee osteoarthritis. However, total knee arthroplasty can produce a large wound in such patients, and destroy the blood circulation environment. The blood flow is then slow and coagulated, forming a hypercoagulable state in the body and further inducing deep vein thrombosis, which seriously impacts surgical efficacy and patient satisfaction. Serious patients have the risk of developing fatal pulmonary embolism, which is a clinical problem concerned by joint surgical experts all over the world.  
OBJECTIVE: To observe the efficacy of Tuina in preventing lower extremity deep venous thrombosis after total knee arthroplasty for knee osteoarthritis.
METHODS:  Using a randomized controlled design, 98 patients with knee osteoarthritis scheduled for primary unilateral total knee arthroplasty were randomly divided into Tuina group and control group (n=49 per group). The control group was treated with oral rivaroxaban tablets after operation, and the Tuina group was treated with Tuina on the basis of oral rivaroxaban tablets. The intervention time was set from the 1st day to the 14th day after operation. The femoral vein stasis index, the incidence of deep venous thrombosis, D-dimer value, pressure pain thresholds, American Knee Society Score, thigh and calf circumference difference, and adverse events were recorded. The clinical trial protocol was approved by the Ethics Committee of Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine on May 16, 2020 (approval No.2020-K-43). Patients who participated in the clinical trial were fully informed of the study protocol and process. Informed consent was signed prior to the start of the clinical trial. This clinical trial was registered at Chinese Clinical Trial Registry on June 4, 2020 (http://www.chictr.org.cn/listbycreater.aspx, ChiCTR2000033537).  
RESULTS AND CONCLUSION: After 14 days of intervention, the total femoral vein stasis index in the Tuina group was significantly lower than that in the control group (P < 0.05). After 14 days of intervention, the incidence of deep venous thrombosis in the Tuina group was lower than that in the control group, but there was no significant difference between the two groups (P > 0.05). After 14 days of intervention, the D-dimer value of the Tuina group was significantly lower than that of the control group (P < 0.05). After 14 days of intervention, pressure pain thresholds at medial and lateral points of the knee joint in the Tuina group were significantly higher than those in the control group (P < 0.05). After 14 days of intervention, the American Knee Society Score of the Tuina group was significantly higher than that of the control group (P < 0.05). After 14 days of intervention, the circumference difference of thigh and calf in the Tuina group was significantly lower than that in the control group (P < 0.05). No adverse events occurred in both groups. To conclude, Tuina is safe and reliable, which can improve the lower limb femoral vein stasis state, reduce the D-dimer value, reduce thigh and calf circumference difference, improve joint pain, and promote joint function rehabilitation.

Key words: knee joint, total knee arthroplasty, Tuina, point-pressing, Shu points, lower limb deep venous, D-dimer

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