Utility of noninvasive endothelial function test for prediction of deep vein thrombosis after total hip or knee arthroplasty.
BACKGROUND
Venous thromboembolism (VTE) is a common and sometimes lethal postoperative complication of arthroplasty. Endothelial dysfunction is important in the pathogenesis of thrombus formation. Reactive hyperemia-peripheral arterial tonometry (RH-PAT) can noninvasively evaluate endothelial function. This study investigated the predictive value of RH-PAT for deep vein thrombosis (DVT) after lower limb arthroplasty.


RESULTS
A prospective observational study of 126 osteoarthritic patients who underwent total knee arthroplasty (TKA) or hip arthroplasty (THA) was conducted. The RH-PAT index (RHI) was measured on the day before surgery, and presence of DVT was checked by ultrasonography or phlebography before and after surgery. Following arthroplasty, DVT was diagnosed in 51 patients (40.5%). RHI in the DVT group (0.58±0.25) was significantly lower than in the non-DVT group (0.71±0.25, P=0.004). RHI was a significant and independent predictor of postoperative DVT in multivariate logistic regression analyses and improved a net reclassification index (23.8%, P=0.022). Subgroup analyses according to operation site with adjustment for Qthrombosis score demonstrated that RHI significantly predicted postoperative DVT in the THA group (odds ratio per 0.1, 0.77; 95% confidence interval 0.60-0.98; P=0.03), but did not reach statistical significance in the TKA group.


CONCLUSIONS
Low RHI was significantly associated with DVT after lower limb arthroplasty. Endothelial dysfunction, as assessed by RH-PAT, is potentially useful for identifying patients at high risk for VTE especially after THA.
Division of Cardiology, Yokohama City University Medical Center.
Hiroyuki
H
Suzuki
Yasushi
Y
Matsuzawa
Masaaki
M
Konishi
Eiichi
E
Akiyama
Keiko
K
Takano
Naoki
N
Nakayama
Shunsuke
S
Kataoka
Toshiaki
T
Ebina
Masami
M
Kosuge
Kiyoshi
K
Hibi
Kengo
K
Tsukahara
Noriaki
N
Iwahashi
Mitsuaki
M
Endo
Nobuhiko
N
Maejima
Kentaro
K
Shinohara
Naoya
N
Taki
Naoto
N
Mitsugi
Masataka
M
Taguri
Seigo
S
Sugiyama
Hisao
H
Ogawa
Satoshi
S
Umemura
Kazuo
K
Kimura
D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000503:physiopathology / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology; D011446:Prospective Studies; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology