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, İncesoy MA, Onaç 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, Kröger 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.	龚恒, 黄斌, 付立功, 等. 全膝关节置换术后小腿肌间静脉血栓临床研究. 中国运动医学杂志, 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.	王剑锋. 人工膝关节置换术围手术期肌间静脉血栓的转归及其影响因素的分析. 西安: 西安医学院, 2021.
9.	张源, 吉忠杰, 张天华, 等. 小腿肌间静脉血栓危险因素及其临床防治的进展. 中国医师进修杂志, 2022, 45(3): 279-284.
10.	杨猛, 江旭, 曹福洋, 等. 单侧全膝关节置换术后下肢肌间静脉血栓形成因素分析及预防. 中华创伤骨科杂志, 2022, 24(2): 155-160.
11.	孙江丽, 张岩, 李虎. 彩色多普勒超声诊断全膝关节置换围手术期下肢深静脉血栓形成的临床价值. 中华医学超声杂志(电子版), 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.	中华医学会骨科学分会. 中国骨科大手术静脉血栓栓塞症预防指南. 中华骨科杂志, 2016(2): 65-71.
14.	李俊来, 曹晓林, 余美琴, 等. 提高彩色多普勒超声诊断下肢深静脉血栓效率的策略研究. 中华医学超声杂志(电子版), 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, 翁习生, 曲铁兵, 等. 中国髋、膝关节置换术加速康复—围术期管理策略专家共识. 中华骨与关节外科杂志, 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, 皮红英, 宋咪, 等. 机械预防深静脉血栓形成的机制及应用研究综述. 解放军医学院学报, 2021, 42(12): 1326-1329.
19.	陈琼. 常熟市全髋关节置换患者术后早期康复的现状及影响因素分析. 苏州: 苏州大学, 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, 马玉芬, 高娜, 等. 加速康复外科理念下全膝关节置换患者术后早期下床活动现状调查. 中国护理管理, 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 Næss 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, 孟尽海, 王文娟, 等. 骨科手术病人术后下肢深静脉血栓形成的危险因素. 中华麻醉学杂志, 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, Akalın Y, Çevik 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, İncesoy MA, Onaç 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, Kröger 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. 龚恒, 黄斌, 付立功, 等. 全膝关节置换术后小腿肌间静脉血栓临床研究. 中国运动医学杂志, 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. 王剑锋. 人工膝关节置换术围手术期肌间静脉血栓的转归及其影响因素的分析. 西安: 西安医学院, 2021.
9. 张源, 吉忠杰, 张天华, 等. 小腿肌间静脉血栓危险因素及其临床防治的进展. 中国医师进修杂志, 2022, 45(3): 279-284.
10. 杨猛, 江旭, 曹福洋, 等. 单侧全膝关节置换术后下肢肌间静脉血栓形成因素分析及预防. 中华创伤骨科杂志, 2022, 24(2): 155-160.
11. 孙江丽, 张岩, 李虎. 彩色多普勒超声诊断全膝关节置换围手术期下肢深静脉血栓形成的临床价值. 中华医学超声杂志(电子版), 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. 中华医学会骨科学分会. 中国骨科大手术静脉血栓栓塞症预防指南. 中华骨科杂志, 2016(2): 65-71.
14. 李俊来, 曹晓林, 余美琴, 等. 提高彩色多普勒超声诊断下肢深静脉血栓效率的策略研究. 中华医学超声杂志(电子版), 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, 翁习生, 曲铁兵, 等. 中国髋、膝关节置换术加速康复—围术期管理策略专家共识. 中华骨与关节外科杂志, 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, 皮红英, 宋咪, 等. 机械预防深静脉血栓形成的机制及应用研究综述. 解放军医学院学报, 2021, 42(12): 1326-1329.
19. 陈琼. 常熟市全髋关节置换患者术后早期康复的现状及影响因素分析. 苏州: 苏州大学, 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, 马玉芬, 高娜, 等. 加速康复外科理念下全膝关节置换患者术后早期下床活动现状调查. 中国护理管理, 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 Næss 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, 孟尽海, 王文娟, 等. 骨科手术病人术后下肢深静脉血栓形成的危险因素. 中华麻醉学杂志, 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, Akalın Y, Çevik 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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