2023, Vol. 27 ›› Issue (13): 2044-2050

Deep vein thrombosis distribution and risk factors after total knee arthroplasty during enhanced recovery after surgery

Wu Qian, Liu Lingfeng, Li Lisong, Lu Yingjie, Zhou Liyu, Xu Wu, Huang Lixin, Jiang Dinghua   

Abstract: BACKGROUND: Deep vein thrombosis is one of the common complications after total knee arthroplasty. In recent years, enhanced recovery after surgery has developed rapidly. However, there is still a lack of large sample studies on the occurrence and risk factors of thrombosis after total knee arthroplasty in China.  
OBJECTIVE: To explore the occurrence of deep vein thrombosis in the lower extremities after total knee arthroplasty during enhanced recovery after surgery, and to further explore the risk factors for postoperative deep vein thrombosis.
METHODS:   A total of 1 260 patients who underwent unilateral total knee arthroplasty for knee osteoarthritis in the First Affiliated Hospital of Soochow University from May 2016 to December 2021 were retrospectively analyzed. According to the results of postoperative venous ultrasound of the lower limbs, the patients were assigned into thrombosis group (n=140) and non-thrombosis group (n=1 120). The differences of various indicators between the two groups were compared by univariate analysis. Finally, the possible meaningful indicators were taken as independent variables into the binary multivariate logistic regression analysis.  
RESULTS AND CONCLUSION: (1) 140 patients suffered from postoperative deep vein thrombosis, of which the incidence of proximal thrombosis was 1.67%, and the incidence of distal thrombosis was 9.44%. In the proximal type, 38.10% of the thrombus involved only one vein, and 61.90% of the patients involved two or more veins. Of the distal type, 79.83% involved a single vein and 20.17% involved two or more veins. (2) Univariate analysis results showed that the proportion of patients with a history of hypertension, a history of deep vein thrombosis and a history of drinking alcohol in the thrombotic group were significantly higher than those of the non-thrombosis group (P < 0.05). (3) Binary multivariate logistic regression analysis showed that a history of preoperative hypertension (OR=1.686, P=0.012, 95%CI=1.123-2.531), a history of deep vein thrombosis (OR=4.794, P < 0.001, 95%CI=2.124-10.820), and a history of alcohol consumption (OR=10.733, P < 0.001, 95%CI=6.942-16.594) were risk factors for the development of deep vein thrombosis after total knee arthroplasty. (4) The results show that although the incidence of proximal thrombosis is not high during the enhanced recovery after surgery, given that it often involves two or more veins, attention should be paid to the evaluation of thrombosis treatment in such patients. Preoperative history of hypertension, previous history of varicose veins, and the presence of alcohol consumption are independent risk factors for the development of deep vein thrombosis in the lower limbs after total knee arthroplasty, so surgeons should focus on the patient's general condition and perform preoperative optimization.
Key words: osteoarthritis, total knee arthroplasty, enhanced recovery after surgery, deep vein thrombosis, logistic regression analysis, risk factor