Department of Orthopaedics, Peking University Third Hospital, Beijing 100191, China.
Chin Med J (Engl). 2011 Dec;124(23):3896-9.
Total knee arthroplasty (TKA) is a successful surgical technique for patients with advanced knee osteoarthritis; however, some peri-operative complications can not be predicted or avoided completely. This study aimed to investigate the factors affecting limb swelling after primary total knee arthroplasty, to guide and improve patient rehabilitation.
Using a hospital database, we retroactively analyzed the mean changes in limb circumferences of 286 consecutive patients who underwent primary unilateral total knee arthroplasty between October 2007 and August 2009. The lower limb circumference change was calculated and analyzed statistically. The influence of age, gender, body mass index, the presence of deep vein thrombosis, methods of anti-coagulation, operation time, hidden blood loss, and type of prosthesis on post-operative lower limb swelling was studied.
Swelling was most pronounced from the third to the fifth post-operative day and usually occurred in both lower limbs. Swelling was significantly more pronounced in the operated limb than in the non-operated limb. The swelling above the knee was also significantly greater than that below the knee. The change in limb circumference at 10 cm above the knee was significantly different between the patients with body mass index ≤ 25 kg/m(2) and those with body mass index > 25 kg/m(2). However, the change in limb circumference at 10 cm below the knee was not significantly different between the two groups. There was no statistically significant difference in limb swelling between different age groups (P > 0.05). Similarly, gender, methods of anti-coagulation, the presence of deep vein thrombosis, the type of prosthesis, and operation time did not significantly affect post-operative limb swelling. Multivariate linear regression showed that the factors affecting post-operative limb swelling were body mass index and hidden blood loss.
Lower limb swelling after total knee arthroplasty is related to early post-operative hidden blood loss. The patient's hemoglobin level should be monitored. The degree of limb swelling is correlated with the patient's body mass index and the amount of hidden blood loss. Early intramuscular deep vein thrombosis formation has little effect on limb swelling.
全膝关节置换术（TKA）是治疗晚期膝关节骨关节炎患者的一种成功的手术技术；然而，一些围手术期并发症是无法完全预测或避免的。本研究旨在探讨影响初次全膝关节置换术后肢体肿胀的因素，以指导和改善患者康复。
我们使用医院数据库回顾性分析了 2007 年 10 月至 2009 年 8 月期间 286 例接受初次单侧全膝关节置换术的连续患者的下肢周径的平均变化。统计分析下肢周径的变化。研究了年龄、性别、体重指数、深静脉血栓形成、抗凝方法、手术时间、隐性失血、假体类型对术后下肢肿胀的影响。
肿胀在术后第 3 至第 5 天最为明显，通常发生在双下肢。患侧肿胀明显大于健侧。膝关节以上肿胀也明显大于膝关节以下。膝关节以上 10cm 处的肢体周径变化在体重指数≤25kg/m2的患者与体重指数>25kg/m2的患者之间有显著差异。然而，两组患者膝关节以下 10cm 处的肢体周径变化无显著差异。不同年龄组之间的肢体肿胀无统计学差异（P>0.05）。同样，性别、抗凝方法、深静脉血栓形成、假体类型和手术时间对术后肢体肿胀无显著影响。多元线性回归显示，影响术后肢体肿胀的因素有体重指数和隐性失血。
全膝关节置换术后下肢肿胀与术后早期隐性失血有关。应监测患者的血红蛋白水平。肢体肿胀程度与患者的体重指数和隐性失血量有关。早期肌内深静脉血栓形成对肢体肿胀影响较小。
