Department of Orthopaedic and Traumatology, Bartın State Hospital, Bartın, Turkey.
Department of Cardiovascular Surgery, Bartın State Hospital, Bartın, Turkey.
Int Orthop. 2021 Oct;45(10):2561-2567. doi: 10.1007/s00264-020-04888-0. Epub 2021 Jan 7.
Post-operative swelling and oedema following total knee arthroplasty (TKA) are one of the most important causes of dissatisfaction. We aimed to assess the clinical variables associated with post-operative swelling and edema after TKA and to compare their performance in respect of predicting them pre-operatively.
The study cohort comprised 116 patients who underwent TKA between January 2018 and May 2019 in our centre. The diameters and the grade of venous insufficiency (VI) in the lower extremity veins were measured with duplex ultrasonography preoperatively and at one and three months post-operatively. The study cohort was divided into the patients with leg swelling positive with a difference in leg circumference of > 2 cm (n = 56, 48.2%) and leg swelling negative with a difference of ≤ 2 cm (n = 60, 51.7%) from the pre-operative leg diameter.
Independent predictors for lower extremity swelling were pre-operative great saphenous diameter (GSV) diameter > 5.5 mm [odds ratio (OR) 2.51, 95% CI 0.24-0.91; p = 0.0012], GSV reflux > 1 s [OR 3.28, 95% CI 1.16-12.1; p = 0.003], deep only VI [OR 1.32, 95% CI 0.74-1.87; p = 0.021], CEAP C4-6 [OR 1.62, 95% CI 0.36-0.91; p = 0.018], and hypothyroidism [OR 1.55, 95% CI 1.31-11.2; p = 0.031].
GSV diameter of > 5.38 mm and GSV reflux duration > 1.23 s had the best predictive value for lower extremity oedema following TKA.
全膝关节置换术后（TKA）的肿胀和水肿是导致患者不满意的最重要原因之一。本研究旨在评估 TKA 术后肿胀和水肿的相关临床变量，并比较其术前预测的表现。
本研究纳入了 2018 年 1 月至 2019 年 5 月期间在我院接受 TKA 的 116 例患者。术前及术后 1 个月和 3 个月时，采用双能超声测量下肢静脉的直径和静脉功能不全（VI）的分级。根据术前下肢周径差值>2cm（56 例，48.2%）将患者分为下肢肿胀阳性组和下肢肿胀阴性组（60 例，51.7%）。
下肢肿胀的独立预测因素为术前大隐静脉直径（GSV）>5.5mm（比值比[OR]2.51，95%可信区间[CI]0.24-0.91；p=0.0012）、GSV 反流>1s（OR 3.28，95%CI 1.16-12.1；p=0.003）、单纯深静脉 VI（OR 1.32，95%CI 0.74-1.87；p=0.021）、CEAP C4-6（OR 1.62，95%CI 0.36-0.91；p=0.018）和甲状腺功能减退（OR 1.55，95%CI 1.31-11.2；p=0.031）。
GSV 直径>5.38mm 和 GSV 反流时间>1.23s 对 TKA 后下肢水肿具有最佳的预测价值。
