Correlation analysis between preoperative Barthel index scores and incidence of lower extremity deep vein thrombosis in revision total hip arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SHEN Ying ^1,2 , YAO Yao ^1,2 , QIAO Liang ^1,2 , WU Dengxian ^1,2 , LI Xihua ^1,2 ,  JIANG Qing ^1,2

1. Department of Orthopedics, Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, 210008, P. R. China;
2. Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing Jiangsu, 210008, P. R. China;

Corresponding author：

JIANG Qing, Email: jiangqing112@hotmail.com

Keywords：

Barthel index score; total hip arthroplasty; lower extremity deep vein thrombosis; revision surgery

DOI：

10.7507/1002-1892.202409075

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Objective To investigate the correlation between the Barthel index score and other factors before revision total hip arthroplasty (THA) and the incidence of lower extremity deep venous thrombosis (DVT). Methods The clinical data of 122 THA revision patients who met the selection criteria between April 2017 and November 2020 were retrospectively analyzed. There were 61 males and 61 females with an average age of 65.3 years ranging from 32 to 85 years. The causes of revision were periprosthetic infection (7 cases), periprosthetic fracture (4 cases), prosthesis dislocation (6 cases), and aseptic loosening (105 cases). The Barthel index score was 76.4±17.7, including 10 cases of grade 1, 57 cases of grade 2, 37 cases of grade 3, and 18 cases of grade 4. Univariate analysis was performed on the age, gender, body mass index, Barthel index score, positive D-dimer, history of diabetes, hypertension, history of tumor, history of cerebral infarction, history of smoking, and history of thrombosis in patients with and without DVT before operation. The risk factors of DVT before revision THA were further screened by logistic regression analysis, and the incidence of DVT before revision THA was compared among different Barthel index grade. Results Eleven patients (9.02%) were found to have preoperative DVT, all of which were intermuscular venous thrombosis. The causes of revision were periprosthetic infection in 1 case, periprosthetic fracture in 1 case, prosthesis dislocation in 1 case, and aseptic loosening of prosthesis in 8 cases. Univariate analysis showed that there were significant differences in age, gender, and Barthel index score between the two groups (P<0.05). Further logistic regression analysis showed that female, age ≥70 years, and Barthel index score <60 were independent risk factors for DVT before THA revision (P<0.05). Preoperative DVT occurred in 0 (0), 2 (3.5%), 3 (8.1%), and 6 (33.3%) patients with Barthel index grade 1, 2, 3, and 4, respectively. There was a correlation between Barthel index grade and the incidence of DVT before THA revision (P=0.001). Conclusion In patients undergoing revision THA, older age, female, and lower Barthel index score were associated with a higher incidence of preoperative DVT. For patients with low preoperative Barthel scores, preoperative screening for thrombosis should be emphasized.

1.	Schwartz BE, Piponov HI, Helder CW, et al. Revision total hip arthroplasty in the United States: national trends and in-hospital outcomes. Int Orthop, 2016, 40(9): 1793-1802.
2.	Kahlenberg CA, Swarup I, Krell EC, et al. Causes of revision in young patients undergoing total hip arthroplasty. J Arthroplasty, 2019, 34(7): 1435-1440.
3.	顾建明, 冯啸, 周一新. 1422例人工髋关节翻修术病因分析. 中华骨与关节外科杂志, 2021, 14(4): 267-271.
4.	Pandey AK, Zuke WA, Surace P, et al. Management of acetabular bone loss in revision total hip replacement: a narrative literature review. Ann Jt, 2023, 9: 21. doi: 10.21037/aoj-23-23.
5.	Kawai T, Goto K, Kuroda Y, et al. Lower activity and function scores are associated with a higher risk of preoperative deep venous thrombosis in patients undergoing total hip arthroplasty. J Clin Med, 2020, 9(5): 1257. doi: 10.3390/jcm9051257.
6.	Kageyama N, Ro A, Tanifuji T, et al. Significance of the soleal vein and its drainage veins in cases of massive pulmonary thromboembolism. Ann Vasc Dis, 2008, 1(1): 35-39.
7.	Sachdeva A, Dalton M, Lees T. Graduated compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev, 2018, 11(11): CD001484. doi: 10.1002/14651858.CD001484.pub4.
8.	Wakabayashi H, Hasegawa M, Niimi R, et al. Clinical analysis of preoperative deep vein thrombosis risk factors in patients undergoing total hip arthroplasty. Thromb Res, 2015, 136(5): 855-858.
9.	Wu JX, Qing JH, Yao Y, et al. Performance of age-adjusted D-dimer values for predicting DVT before the knee and hip arthroplasty. J Orthop Surg Res, 2021, 16(1): 82. doi: 10.1186/s13018-020-02172-w.
10.	Xu K, Chan NC, Ibrahim Q, et al. Reduction in mortality following elective major hip and knee surgery: A systematic review and meta-analysis. Thromb Haemost, 2019, 119(4): 668-674.
11.	Akram F, Fan BE, Tan CW, et al. The clinical application of venous ultrasound in diagnosis and follow-up of lower extremity deep vein thrombosis (DVT): a case-based discussion. Thromb J, 2023, 21(1): 110. doi: 10.1186/s12959-023-00550-y.
12.	Chen Z, Sax OC, Bains SS, et al. Super-obese patients are associated with significant infection burden after total hip arthroplasty. Hip Int, 2023, 33(5): 806-811.
13.	Zhou L, Feng C, Lu Y, et al. Development and validation of health-oriented personal evaluation for the community-dwelling older person based on the International Classification of Functioning, Disability and Health. Int J Older People Nurs, 2024, 19(3): e12609. doi: 10.1111/opn.12609.
14.	Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest, 2008, 133(6 Suppl): 381S-453S.
15.	Piovella F, Wang CJ, Lu H, et al. Deep-vein thrombosis rates after major orthopedic surgery in Asia. An epidemiological study based on postoperative screening with centrally adjudicated bilateral venography. J Thromb Haemost, 2005, 3(12): 2664-2670.
16.	Strini V, Piazzetta N, Gallo A, et al. Barthel Index: creation and validation of two cut-offs using the BRASS Index. Acta Biomed, 2020, 91(2-S): 19-26.
17.	Hoyer EH, Bhave A, Xue W, et al. Inaccuracy of initial clinical mobility assessment in venous thromboembolism risk stratification. Am J Med, 2024, 137(8): 776-781.
18.	Zhang ZH, Shen B, Yang J, et al. Risk factors for venous thromboembolism of total hip arthroplasty and total knee arthroplasty: a systematic review of evidences in ten years. BMC Musculoskelet Disord, 2015, 16: 24. doi: 10.1186/s12891-015-0470-0.
19.	Abe K, Yuda S, Yasui K, et al. Soleal vein dilatation assessed by ultrasonography is an independent predictor for deep vein thrombosis after major orthopedic surgery. J Cardiol, 2017, 69(5): 756-762.
20.	Tornero-Quiñones I, Sáez-Padilla J, Espina Díaz A, et al. Functional ability, frailty and risk of falls in the elderly: relations with autonomy in daily living. Int J Environ Res Public Health, 2020, 17(3): 1006. doi: 10.3390/ijerph17031006.

1. Schwartz BE, Piponov HI, Helder CW, et al. Revision total hip arthroplasty in the United States: national trends and in-hospital outcomes. Int Orthop, 2016, 40(9): 1793-1802.
2. Kahlenberg CA, Swarup I, Krell EC, et al. Causes of revision in young patients undergoing total hip arthroplasty. J Arthroplasty, 2019, 34(7): 1435-1440.
3. 顾建明, 冯啸, 周一新. 1422例人工髋关节翻修术病因分析. 中华骨与关节外科杂志, 2021, 14(4): 267-271.
4. Pandey AK, Zuke WA, Surace P, et al. Management of acetabular bone loss in revision total hip replacement: a narrative literature review. Ann Jt, 2023, 9: 21. doi: 10.21037/aoj-23-23.
5. Kawai T, Goto K, Kuroda Y, et al. Lower activity and function scores are associated with a higher risk of preoperative deep venous thrombosis in patients undergoing total hip arthroplasty. J Clin Med, 2020, 9(5): 1257. doi: 10.3390/jcm9051257.
6. Kageyama N, Ro A, Tanifuji T, et al. Significance of the soleal vein and its drainage veins in cases of massive pulmonary thromboembolism. Ann Vasc Dis, 2008, 1(1): 35-39.
7. Sachdeva A, Dalton M, Lees T. Graduated compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev, 2018, 11(11): CD001484. doi: 10.1002/14651858.CD001484.pub4.
8. Wakabayashi H, Hasegawa M, Niimi R, et al. Clinical analysis of preoperative deep vein thrombosis risk factors in patients undergoing total hip arthroplasty. Thromb Res, 2015, 136(5): 855-858.
9. Wu JX, Qing JH, Yao Y, et al. Performance of age-adjusted D-dimer values for predicting DVT before the knee and hip arthroplasty. J Orthop Surg Res, 2021, 16(1): 82. doi: 10.1186/s13018-020-02172-w.
10. Xu K, Chan NC, Ibrahim Q, et al. Reduction in mortality following elective major hip and knee surgery: A systematic review and meta-analysis. Thromb Haemost, 2019, 119(4): 668-674.
11. Akram F, Fan BE, Tan CW, et al. The clinical application of venous ultrasound in diagnosis and follow-up of lower extremity deep vein thrombosis (DVT): a case-based discussion. Thromb J, 2023, 21(1): 110. doi: 10.1186/s12959-023-00550-y.
12. Chen Z, Sax OC, Bains SS, et al. Super-obese patients are associated with significant infection burden after total hip arthroplasty. Hip Int, 2023, 33(5): 806-811.
13. Zhou L, Feng C, Lu Y, et al. Development and validation of health-oriented personal evaluation for the community-dwelling older person based on the International Classification of Functioning, Disability and Health. Int J Older People Nurs, 2024, 19(3): e12609. doi: 10.1111/opn.12609.
14. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest, 2008, 133(6 Suppl): 381S-453S.
15. Piovella F, Wang CJ, Lu H, et al. Deep-vein thrombosis rates after major orthopedic surgery in Asia. An epidemiological study based on postoperative screening with centrally adjudicated bilateral venography. J Thromb Haemost, 2005, 3(12): 2664-2670.
16. Strini V, Piazzetta N, Gallo A, et al. Barthel Index: creation and validation of two cut-offs using the BRASS Index. Acta Biomed, 2020, 91(2-S): 19-26.
17. Hoyer EH, Bhave A, Xue W, et al. Inaccuracy of initial clinical mobility assessment in venous thromboembolism risk stratification. Am J Med, 2024, 137(8): 776-781.
18. Zhang ZH, Shen B, Yang J, et al. Risk factors for venous thromboembolism of total hip arthroplasty and total knee arthroplasty: a systematic review of evidences in ten years. BMC Musculoskelet Disord, 2015, 16: 24. doi: 10.1186/s12891-015-0470-0.
19. Abe K, Yuda S, Yasui K, et al. Soleal vein dilatation assessed by ultrasonography is an independent predictor for deep vein thrombosis after major orthopedic surgery. J Cardiol, 2017, 69(5): 756-762.
20. Tornero-Quiñones I, Sáez-Padilla J, Espina Díaz A, et al. Functional ability, frailty and risk of falls in the elderly: relations with autonomy in daily living. Int J Environ Res Public Health, 2020, 17(3): 1006. doi: 10.3390/ijerph17031006.

Chinese Journal of Reparative and Reconstructive Surgery

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