Pichonnaz Claude, Bassin Jean-Philippe, Lécureux Estelle, Currat Damien, Jolles Brigitte M
Physiotherapy Department, Haute Ecole de Santé Vaud (HESAV), HES-SO, University of Applied Sciences Western Switzerland, Delémont, Switzerland.
CHUV-UNIL, Orthopedics and Traumatology Department, CHUV-UNIL, Avenue du Bugnon 21, 1011, Lausanne, Switzerland.
BMC Musculoskelet Disord. 2015 Apr 25;16:100. doi: 10.1186/s12891-015-0559-5.
The evaluation of swelling is important for the outcome of total knee arthroplasty (TKA) surgery. The circumference or volume measurements are applicable at the bedside of the patient but are altered by muscular atrophy and the post-surgical dressing. Bioimpedance spectroscopy might overcome these limitations; however, it should be validated. This study aimed to explore the validity, the reliability and the responsiveness of bioimpedance spectroscopy for measuring swelling after TKA.
The degree of swelling in 25 patients undergoing TKA surgery was measured using bioimpedance spectroscopy (BIS R0), knee circumference and limb volume. The measurements were performed on D-1 (day before surgery), D + 2 (2 days after surgery) and D + 8 (8 days after surgery). The BIS R0 measurements were repeated twice, alternating between two evaluators. The percentage of the difference between the limbs was calculated for BIS R0, circumference and volume. The intra- and inter-observer intraclass correlation coefficients (ICCs), limits of agreement (LOA), effect size (Cohen's d), correlations between the methods and diagnostic sensitivity were calculated.
BIS R0, circumference and volume detected swelling < 3.5% at D-1. The swelling at D2 and D8 was greater with BIS R0 [mean (SD) 29.9% (±9.8) and 38.27 (±7.8)] than with volume [14.7 (±9.5) and 14.9 (±8.2)] and circumference [11.1 (±5.7) and 11.7 (±4.1)]. The BIS R0 intra- and inter-evaluator ICCs ranged from 0.89 to 0.99, whereas the LOA were < 5.2%. The BIS R0 correlation was 0.73 with volume and 0.75 with circumference. The BIS R0 Cohen's d was 3.32 for the D-1-D2 evolution. The diagnostic sensitivity was 83% D2 and 96% at D8.
Bioimpedance is a valid method for the evaluation of swelling following TKA. BIS R0 also demonstrated excellent intra- and inter-evaluator reliability. The diagnostic sensitivity and responsiveness is superior to that of concurrent methods. BIS R0 is an efficient method for post-surgical follow up at the bedside of the patient. The measurement of BIS R0 is a straightforward, valid, reliable and responsive method for lower limb swelling following TKA surgery that could be used in clinics and research.
ClinicalTrials.gov Identifier: NCT00627770.
肿胀评估对于全膝关节置换术（TKA）的手术效果很重要。周长或体积测量可在患者床边进行，但会受到肌肉萎缩和术后敷料的影响。生物电阻抗光谱法可能克服这些局限性；然而，它需要得到验证。本研究旨在探讨生物电阻抗光谱法在测量TKA术后肿胀方面的有效性、可靠性和反应性。
使用生物电阻抗光谱法（BIS R0）、膝关节周长和肢体体积测量25例行TKA手术患者的肿胀程度。测量在术前1天（D-1）、术后2天（D + 2）和术后8天（D + 8）进行。BIS R0测量重复两次，由两名评估者交替进行。计算BIS R0、周长和体积的双侧差异百分比。计算观察者内和观察者间组内相关系数（ICC）、一致性界限（LOA）、效应大小（科恩d值）、方法间的相关性以及诊断敏感性。
在D-1时，BIS R0、周长和体积检测到的肿胀均<3.5%。在D2和D8时，BIS R0检测到的肿胀程度更大[均值（标准差）为29.9%（±9.8）和38.27（±7.8）]，高于体积[14.7（±9.5）和14.9（±8.2）]和周长[11.1（±5.7）和11.7（±4.1）]。BIS R0评估者内和评估者间的ICC范围为0.89至0.99，而LOA<5.2%。BIS R0与体积的相关性为0.73，与周长的相关性为0.75。D-1至D2变化的BIS R0科恩d值为3.32。D2时的诊断敏感性为83%，D8时为96%。
生物电阻抗是评估TKA术后肿胀的有效方法。BIS R0在评估者内和评估者间也显示出出色的可靠性。其诊断敏感性和反应性优于同期方法。BIS R0是患者床边术后随访的有效方法。BIS R0测量是一种用于TKA术后下肢肿胀的直接、有效、可靠且具有反应性的方法，可用于临床和研究。
ClinicalTrials.gov标识符：NCT00627770。
