Somrak Parkpoom, Tanavalee Aree, Ngarmukos Srihatach, Tanavalee Chotetawan, Amarase Chavarin, Jaruthien Nonn, Kampitak Wirinaree
Advanced Arthritis and Arthroplasty Center, Department of Orthopaedics, Bumrungrad International Hospital, Bangkok, Thailand.
Biologics for Knee Osteoarthritis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Knee Surg Relat Res. 2024 Dec 16;36(1):46. doi: 10.1186/s43019-024-00251-4.
Body fluid retention after major surgeries, including total knee arthroplasty (TKA), is well documented in the literature. Currently, multimodal pain control protocols consisting of several medications together with early discharge protocol may magnify this adverse event after a patient's discharge. However, no study has focused on the quantitative and chronological changes in body fluids following modern pain management protocols for TKA. The aim of this study was to investigate the perioperative total body water (TBW) change in patient undergoing TKA.
A consecutive series of 85 patients undergoing primary unilateral TKA, with uniform hospital admission, multimodal pain control, and rehabilitation protocol, had five consecutive multifrequency bioelectrical impedance analysis (BIA) scans; baseline, postoperative day 1 (POD 1), postoperative day 3 (POD 3), 2 weeks, and 6 weeks. Changes in TBW, body weight, corticosteroid-fluid retention dose-response relationship, and complications were evaluated.
Seventy patients completed all five scans and follow-ups. Female patients were dominant, with a mean age of 69.5 years. There were no perioperative complications. At 24 h, the mean total fluid input and output were 3695.14 mL and 1983.43 mL, respectively, with 1711.71 mL increments and a mean accumulative dosage of dexamethasone of 15.14 mg. The mean TBW increased by 2.61 L on POD 1 and continued to peak at 3.2 L on POD 3, then gradually decreased at 2 weeks and reached the baseline level at 6 weeks postoperatively. Similarly, the mean body weight increased to 2.8 kg on POD 1, reached the maximum point at 3.42 kg on POD 3, and returned to baseline at 6 weeks.
Fluid retention following multimodal pain control in TKA increased from POD 1, peaked on POD 3, and gradually returned to the baseline at 6 weeks. With early discharge protocol, patient education regarding fluid retention after discharge should be considered.
包括全膝关节置换术（TKA）在内的大手术后体液潴留现象在文献中有充分记载。目前，由多种药物组成的多模式疼痛控制方案以及早期出院方案可能会在患者出院后加剧这一不良事件。然而，尚无研究关注TKA现代疼痛管理方案后体液的定量和时间变化。本研究的目的是调查接受TKA患者围手术期的总体水（TBW）变化。
连续85例接受初次单侧TKA的患者，采用统一的入院、多模式疼痛控制和康复方案，连续进行五次多频生物电阻抗分析（BIA）扫描；基线、术后第1天（POD 1）、术后第3天（POD 3）、2周和6周。评估TBW、体重、皮质类固醇-体液潴留剂量反应关系及并发症的变化。
70例患者完成了所有五次扫描及随访。女性患者占主导，平均年龄69.5岁。无围手术期并发症。术后24小时，平均总液体摄入量和排出量分别为3695.14 mL和1983.43 mL，增加了1711.71 mL，地塞米松平均累积剂量为15.14 mg。TBW在POD 1时平均增加2.61 L，并在POD 3时继续达到峰值3.2 L，然后在2周时逐渐下降，术后6周恢复到基线水平。同样，平均体重在POD 1时增加到2.8 kg，在POD 3时达到最高点3.42 kg，并在6周时恢复到基线。
TKA多模式疼痛控制后的体液潴留从POD 1开始增加，在POD 3达到峰值，并在6周时逐渐恢复到基线。采用早期出院方案时，应考虑对患者进行出院后体液潴留的教育。
