Study Of Factors Influencing Limb Swelling After Total Knee Arthroplasty

Objective:This project aims to improve the development of postoperative lower extremity swelling and promote early and rapid functional recovery of patients,thus improving their postoperative limb rehabilitation training.A line graph was established to predict the risk of swelling of the affected limb after TKA based on the factors that can significantly affect the swelling of the affected limb after TKA.Methods:A total of 203 patients who underwent initial total knee replacement in the orthopedic joint ward of the Third Hospital of Shanxi Medical University from 2021-01-15 to2022-12-31 were first identified,and then the clinical data information of these 203 patients was compiled and collected.LASSO regression analysis was performed based on the 203 patients,and the LASSO regression results showed the influential factors associated with the occurrence of postoperative swelling in patients undergoing initial total knee replacement;then logistic single-factor and multi-factor regression analyses were performed on the screened influential factors to finally determine the independent influential factors for the occurrence of postoperative swelling in patients undergoing initial total knee replacement.Finally,based on the results of the logistic single-factor and multi-factor regression,we again developed a line graph with good accuracy to predict the risk of lower limb swelling in patients after total knee replacement,i.e.,a prediction model,and performed internal validation to demonstrate the good accuracy and precision of our prediction model.Results:A total of 203 patients who met the criteria were included in this study,of which the analysis of the patients’ baseline information revealed that there were 58 male(28.6%)patients and 145 female patients(71.4%),and 40(20.7%)had a BMI greater than 24.0.LASSO regression analysis was performed on the data information of 203 patients,and the results of LASSO regression analysis showed that age,gender,BMI,whether or not to smoke,whether or not to drink alcohol,affected side,presence of other diseases,duration of osteoarthritis of the knee,duration of surgery,amount of bleeding during surgery,and amount of blood transfusion during surgery were the variables of interest.Then,we performed Logistic univariate and multivariate regression analysis on the data information of 203 patients,where Logistic univariate regression analysis showed p-values <0.05 for age,body mass index BMI,duration of disease,duration of surgery,and intraoperative bleeding,which were statistically significant.Meanwhile,our final results by logistic multiple factor regression analysis showed that age,body mass index BMI,duration of disease,duration of surgery,and bleeding volume were significant influencing factors for the occurrence of lower extremity swelling after surgery in patients with initial total knee replacement.Ultimately,the results of the analysis by multiple regression studies revealed that age,body mass index BMI,duration of disease,duration of surgery,and bleeding were independent risk factors for the development of lower extremity swelling after surgery in patients undergoing initial total knee replacement.Based on these studies,we developed a model that can predict the risk of lower extremity swelling after surgery in patients with initial total knee replacement,and we performed an internal validation of the accuracy of this model developed by ROC curves,calibration plots on column plots in order to verify the accuracy of the model developed.Conclusion:The results of LASSO regression analysis showed that age,sex,BMI,affected side,presence of other diseases,and duration of course of knee osteoarthritis were significant variables;the screened influencing factors were again subjected to Logistic univariate and multivariate regression analysis to finally identify independent influencing factors for the occurrence of postoperative swelling in patients with initial total knee arthroplasty.The construction of column line graphs that could accurately predict the occurrence of swelling in the lower extremity after TKA was performed based on five variables that were statistically significant(age,body mass index BMI,duration of disease,duration of surgery,and bleeding).In addition,we collected patients from time periods different from the modeled population as a validation population to verify the accuracy and precision of the constructed column line graphs.The final results showed that the area under the curve of the ROC curve for the validation population was 0.844,and this result also showed that our constructed column line graphs had better accuracy.The results of the calibration chart for the validation population were also satisfactory,so we have enough evidence to prove that our established column line chart has a satisfactory effect on predicting the risk of swelling in the lower extremity after TKA.The column line chart we have established allows clinical workers to intervene or manage in advance patients who are at high risk of developing lower extremity swelling after TKA,and to be able to develop individualized risk scores for different patients,which has better clinical implications.