Risk Factors Of Deep Venous Thrombosis In Lower Extremities After Total Knee Arthroplasty

Objective:To investigate risk factors related to Deep Venous Thrombosis DVT)after Total Knee Arthroplasty(TKA),in order to scientifically evaluate the risk of postoperative DVT formation before TKA and develop individualized hrombus prevention programs in the future.Methods:A total of 342 patients who received TKA treatment in the first ospital of Lanzhou university from January 2016 to December 2018 and accorded with the inclusion and exclusion standards of the study were selected to study the risk factors of DVT after TKA by univariate and unconditioned multivariate logistic egression analysis.The statistical indexes included age,sex,body mass index(BMI),drinking,smoking,anesthesia method,the displacement mode,operation duration, peration season,operation year,infection,hypertension,diabetes,coronary heart disease,hyperlipedemia,chronic heart failure,history of venous thromboembolism(VTE),history of transient ischemic attack(TIA),history of cerebral infarction, istory of varicose veins in lower limbs,malignant tumor,homocysteine(Hcy), heumatoid arthritis(RA),D-dimer,international normalized ratio(INR),prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT), ibrinogen(FIB),hematocrit(HCT),platelet(PLT).Result:A total of 48 cases occurred DVT in 342 patients who underwent TKA.The morbidity was 14.04%.The univariate analysis showed that the incidence of DVT in lower limb after TKA for 17 factors was higher,and the difference was statistically significant(p<0.05).The 17 factors were respectlively age greater than 60(x~2=9.178,p=0.002),female(x~2=4.734,p=0.030),BMI more than 25kg/m~2(x~2=7.420,p=0.006),smoking(x~2=8.054,p=0.006),treatment in autumn or winter(x~2=11.601,p=0.009),general anesthesia(x~2=8.697,p=0.003),operation time greater than 90min(x~2=8.585,p=0.003),operation year(x~2=17.156,p<0.001),bilateral simultaneous displacement(x~2=7.411,p=0.006),history of VTE(x~2=24.060,p<0.001),history of varicose veins in lower limbs(x~2=17.202,p<0.001),diabetes(x~2=8.541,p=0.003),history of erebral infarction(x~2=10.922,p=0.001),hyperlipidemia(x~2=11.779,p=0.001), alignant tumor(x~2=7.870,p=0.005),D-dimer(t=2.175,p=0.030),high Hcy level(x~2=9.476,p=0.002).The incidence of DVT in lower limb after TKA for 1 factor was less,and the difference was statistically significant(p<0.05).The factor was RA x~2=379.046,p<0.001).There was no significant difference in the incidence of DVT after TKA for other 13 factors(p>0.05).The above 18 statistically significant factors were further analyzed by multivariate non-conditional logistic regression analysis,the logistic regression indicated that for 14 factors,the regression coefficient(?)was ore than 0,the odds ratio(OR)was more than 1,and the difference was statistically significant(p<0.05).The 14 factors were respectlively age greater than 60(?=2.148,OR=12.312,p=0.004),BMI more than 25kg/m~2(?=0.149,OR=2.152,p=0.023),smoking(?=1.382,OR=1.418,p=0.001),treatment in autumn(?=1.340,OR=1.031,p=0.009),treatment in winter(?=1.632,OR=1.612,p=0.003),general anesthesia ?=1.426,OR=5.125,p=0.003),operation time greater than 90min(?=1.315, R=2.361,p=0.019),bilateral simultaneous displacement(?=1.001,OR=2.200,p=0.036),history of VTE?=2.457,OR=7.296,p=0.031),history of varicose veins in lower limbs(?=1.541,OR=4.087,p=0.020),diabetes(?=1.668,OR=2.477,p=0.001),history of cerebral infarction(?=2.617,OR=6.736,p=0.005),hyperlipidemia ?=2.391,OR=3.154,p=0.001),malignant tumor(?=1.118,OR=1.957,p=0.006)and high Hcy level(?=0.865,OR=1.506,p=0.036).For 1 factor,the?was less than 0,the OR was less than 1,and the difference was statistically significant(p<0.05).The actor was RA(?=-1.542,OR=0.283,p=0.003).There was no statistically significant difference in three factors of female,surgical age and D-dimer(p>0.05).Conclusion:(1)A total of 17 factors were closely related to the formation of VT after TKA,they were respectlively age,female,obesity,smoking,treatment in autumn or winter,general anesthesia,operation time,operation year,bilateral simultaneous displacement,history of VTE,history of varicose veins in lower limbs,diabetes,history of cerebral infarction,hyperlipidemia,malignant tumor,D-dimer,high Hcy level.In addition,the other 14 factors besides female,surgical age and D-dimer were independent risk factors of DVT after TKA.(2)RA was an independent protective factor of DVT after TKA.