人工膝関節置換術後における近位型深部静脈血栓症発生の危険因子の検討

抄録

Objective: Unlike distal deep vein thrombosis (DVT), proximal DVT has a high risk of causing pulmonary embolism (PE). The purpose of this study was to investigate the risk factors of proximal DVT after total knee arthroplasty (TKA) in Japanese patients.

Methods: The study included 460 knees in 376 patients who underwent primary TKA (FINE^® Total Knee System) between March 2011 and May 2017 at our hospital. Patients included 70 men and 306 women, with a mean age of 72.6 years. To evaluate the presence or absence of DVT, all patients received Doppler ultrasonography (US) preoperatively and on postoperative days (PODs) 2 and 14. Patients with preexisting DVT were detected preoperatively and were excluded from the study.

We investigated the following as risk factors: age, gender, rheumatoid arthritis, range of motion, hypertension, diabetes mellitus, hyperlipidemia, history of venous thromboembolism, hormonal therapy, malignancy, bilateral TKA, operative time, postoperative anticoagulant therapy, and plasma D-dimer values on PODs 3, 7, and 14. We compared these risk factors between the proximal DVT-positive and DVT-negative groups.

Results: DVT was detected in 127 knees (27.6%), including 11 knees with proximal DVT (2.4%). A univariate analysis demonstrated that there was a significant difference in age between the proximal DVT-positive and DVT-negative groups. However, no significant differences were found between the two groups by a multivariate logistic regression analysis.

Conclusion: To our knowledge, this is the first study to investigate the risk factors of proximal DVT after TKA. However, we could not identify independent risk factors from this study.