The Relationship Between Seasonal Variations Or The Pain After Arthroplasty And Incidence Of Deep Vein Thrombosis Following Total Knee Or Hip Arthroplasty

Chaper1:Seasonal variations in the incidence of deep vein thrombosis following total knee or hip arthroplastyObjective:To explore the relationship between seasonal variations and deep vein thrombosis(DVT)following total knee arthroplasty(TKA)or total hip arthroplasty(THA).Methods:This retrospective study examined 2 363 patients undergoing primary unilateral TKA or THA from August 2008 to February 2016.There were 653 male and 1 710 female with the age 17?91years old.Routine venography of the bilateral lower limbs was performed between 3?5 days after the operation.The incidence of DVT between different seasons and different age groups(age?65 years old and age<65 years old)were counted.Results:Our date suggested that the probabilities of DVT after arthroplasty in spring,summer,fall and winter were 15.85%,14.92%,17.88%,22.50%,and they were significantly different(p=0.005).The probabilities of DVT after TKA in spring,summer,fall and winter were 19.09%,15.67%,18.11%,27.71%,and they were significantly different(P=0.022).The probabilities of DVT after THA in spring,summer,fall and winter were 13.48%,14.17%,17.73%,20.26%,and they were significantly different(P=0.044).The symptomatic DVT after arthroplasty in spring,summer,fall and winter were 3.55%,3.78%,4.97%,6.90%,and they were also significantly different in different seasons(p=0.024).The symptomatic DVT after TKA in spring,summer,fall and winter were 3.88%,4.24%,4.94%,9.64%,and they were also significantly different in different seasons(P=0.043).The symptomatic DVT after THA in spring,summer,fall and winter were 3.31%,3.33%,4.99%,5.71%,while the difference was not detected in different seasons(P=0.293).The probability of DVT following arthroplasty in older patients(age>65 years old)in spring,summer,fall and winter were 18.49%,16.61%,22.07%,28.05%,and they were significantly different(p=0.002).The symptomatic probability of DVT following arthroplasty in older patients(age>65 years old)in spring,summer,fall and winter were 4.38%,4.43%,5.72%,8.78%,and they were significantly different(P=0.043).The probability of DVT in four seasons were 12.46%,12.68%,11.39%,12.63%,in younger patients(age<65 years old),however,the difference was not detected in different seasons(P=0.972).The probability of symptomatic DVT in four seasons were 2.49%,2.93%,3.80%,3.54%,in younger patients(age<65 years old),and they were not different(P=0.822).Conclusion:Seasonal variations have an important effect on the incidence of DVT following TKA or THA arthroplasty,especially among older patients(age>65 years old).Chaper2:The relationship between the pain score after arthroplasty and the incidence of deep vein thrombosisObjective:To explore the relationship between the pain after total knee arthroplasty(TKA)or total hip arthroplasty(THA)and deep vein thrombosis(DVT).Methods:Retrospective study and prospective study were combined.Retrospective study included 1 445 primary unilateral TKA or THA patients from March 2010 to August 2014.All patients underwent venography of bilateral lower extremity deep vein at 3-5 days postoperatively and visual analogue scale(VAS)was performed before venography.Prospective study included 343 primary unilateral TKA or THA patients from February 2016 to September 2016.All patients underwent color doppler ultrasound of bilateral lower extremity deep vein to exclude patients with preoperative DVT and then underwent color doppler ultrasound of lower extremity deep vein postoperative 1 day,3 days,7 days or before discharge,6 weeks and 3 months.VAS were performed before DVT screening.The VAS scored based on the pain at day,night,rest and activity.Results:The total incidence rate of DVT in 1 445 patients was 16.12%(233 patients)and no-DVT was 83.88%(1 212 patients)in retrospective study.DVT patients' average VAS score was 3.34±1.43,and none-DVT patients'average VAS score was 2.97±1.29 and they were significantly different(P<0.001).The incidence of DVT in 900 mild pain patients was 13.00%(117 patients),and the incidence of DVT in 545 moderate-severe pain patients was 21.28%(116 patients),and they were significantly different(P<0.001).Correlation analysis was performed between VAS score and the incidence of DVT,r=0.86 and P<0.01.In prospective study,343 patients were included.The VAS score of pain at day,night,rest and activity were analyzed at postoperative 1 day,3 days,7 days or before discharge,6 weeks and 3 months.The DVT patients' VAS score at day and activity were higher than none-DVT patients at postoperative 7 days,the difference was statistically significant(two P<0.001).Other pain groups or pain at other time showed no significant difference.Patients were divided into two groups of mild pain patients and moderate-severe pain patients according to the pain at day,night,rest and activity.When divided into two groups according to the pain at day or activity,the incidence of DVT in moderate-severe pain patients were also higher than mild pain patients at postoperative 7 days,and the difference was statistically significant(two P<0.05).Other pain groups or pain at other time showed no significant difference.Conclusion:The VAS score of pain after arthroplasty is related to the incidence of DVT.DVT patients' VAS score was higher than none-DVT patients' and the incidence of DVT in moderate-severe pain patients was higher than mild pain patients too.The pain at day and activity at postoperative 7 days show most meaningful in the relationship between pain and DVT.