深部静脈血栓症の発生が人工膝関節の術後関節可動域に及ぼす影響

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概要

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• Objective: We assessed the effect of deep vein thrombosis (DVT) on the restoration of the range of motion (ROM) after total knee arthroplasty (TKA).Methods: Ninety-five knees in 85 patients who underwent primary unilateral TKA were investigated. The same posterior-stabilized prosthesis was implanted in all knees by using a uniform surgical technique. Physical prophylaxis was prescribed for all knees; in addition, 1.5 mg fondaparinux was injected subcutaneously once daily for 10 days after surgery in 77 knees (81.1%) as prophylaxis against DVT. DVT was confirmed using ultrasound when symptoms of DVT occurred or when plasma D-dimer levels on postoperative days 3 or 7 were ≥ 10 μg/ml. We found that 15 patients had developed DVT. The fifteen knees with DVT (group D) and 80 knees without DVT (group C) were compared.Results: Patient characteristics such as age at surgery, gender, and body mass index were similar in the two groups. The ROM was not significantly different between the groups before surgery or at 3 months after surgery. However, the average active flexion at 1 week after surgery was 81° for group D and 89° for group C. The average postoperative days on which the patients achieved 90° of flexion were 11.8 days for group D and 7.0 days for group C. These differences were statistically significant (P = 0.019, P = 0.0064, respectively).Conclusion: This study showed that DVT delayed the return of early flexion after TKA. Leg pain and swelling associated with DVT, transient discontinuation of postoperative rehabilitation, and anxiety about the development of pulmonary embolism during physiotherapy may interfere with the restoration of ROM.

• 日本関節病学会の論文

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