Analysis Of Deep Venous Thrombosis And Risk Factors In Patients With Rheumatoid Arthritis After Total Knee Arthroplasty

Objective To analyze the incidence of deep venous thrombosis after total knee arthroplasty in patients with rheumatoid arthritis and to analyze the risk factors.Methods We conducted a retrospective analysis of 116 cases of rheumatoid arthritis patients undergoing total knee arthroplasty in the Department of Sports Medicine and Adult Reconstructive Surgery,Nanjing Drum Tower Hospital from March 2010 to December 2018,including 12 males and 104 females.General information and various of data during and after operation was recorded,including age,gender,body mass index,hypertension,diabetes,triglycerides,postoperative bed rest time,pain visual analogue scale are recorded.We performed examination to all the patients to screen deep venous thrombosis.Because of the advances of technology,there were two methods.Radiography of lower Extremity Vein was used before 2015 and color doppler ultrasound was used latter.According to the results of the examination,we excluded those patients that had already got thrombosis before the surgery.Then we divided the included patients into thrombosis group and non-thrombosis group according to the incidence of new deep vein thrombosis and compared the difference of figures.The rate of thrombosis was calculated.Then we used the univariate analysis to show the difference of date between the two groups.(t-test for counting variable and chi-square test for classified variable).After that,we analyzed the meaningful date with logistic regression to find the independent risk factors of deep vein thrombosis after total knee arthroplasty.Results 94 patients was included in this research and among them 4 patients accepted bilateral operation at the same time and 22 patients accepted operations of left and right knee at different time.There were 116 cases included in total.The average age of all the patients was 57.31±11.02 years old(26-81).Among the patients 12 were males and 104 were females.58 patients were screened by radiography and 58 were screened with]ultrasound.The average time they accepted the examination was 3.63±1.17 after operation.17 patients developed deep vein thrombosis,and the incidence rate was 14.7%(17/116).6 cases were confirmed by radiography and 11 were confirmed by ultrasound.All the thrombosis was stable and 11 cases were asymptomatic deep vein thrombosis and 4 cases were symptomatic deep vein thrombosis.Among the symptomatic deep vein thrombosis cases,2 got swollen joint and the other 2 cases showed positive Homans sign and Neuhof sign respectively.No pulmonary embolism occurred.Univariate analysis showed that older patients tend to be more susceptible to deep vein thrombosis and the rate of two groups showed significant difference(p=0.025,t=2.272).Also,people over 65 have higher deep vein thrombosis rate then those in the younger group(p=0.049,t=3.883).Other data index like gender,body mass index,hypertension,diabetes,triglycerides,postoperative bed rest time,pain visual analogue scale showed no significance.Multivariate regression analysis reveals that age ? 65 years was an independent risk factor of postoperative deep vein thrombosis(OR=0.265,p=0.032).Conclusion The incidence of deep vein thrombosis after total knee arthroplasty in patients with rheumatoid arthritis is not low.During clinical work,we should pay more attention to patients with rheumatoid arthritis and enhance the monitoring of thrombosis.Higher age brings about higher risk for thrombosis and age ? 65 years is an independent risk factor for deep vein thrombosis after total joint replacement in patients with rheumatoid arthritis.As a result,we suggest to conduct more aggressive thromboprophylaxis to patients in this age group.