title: Bioimpedance spectroscopy for swelling evaluation following total knee arthroplasty: a validation study.
abstract: BACKGROUND
  The evaluation of swelling is important for the outcome of total knee arthroplasty (TKA) surgery. The circumference or volume measurements are applicable at the bedside of the patient but are altered by muscular atrophy and the post-surgical dressing. Bioimpedance spectroscopy might overcome these limitations; however, it should be validated. This study aimed to explore the validity, the reliability and the responsiveness of bioimpedance spectroscopy for measuring swelling after TKA.
  
  
  METHODS
  The degree of swelling in 25 patients undergoing TKA surgery was measured using bioimpedance spectroscopy (BIS R0), knee circumference and limb volume. The measurements were performed on D-1 (day before surgery), D + 2 (2 days after surgery) and D + 8 (8 days after surgery). The BIS R0 measurements were repeated twice, alternating between two evaluators. The percentage of the difference between the limbs was calculated for BIS R0, circumference and volume. The intra- and inter-observer intraclass correlation coefficients (ICCs), limits of agreement (LOA), effect size (Cohen's d), correlations between the methods and diagnostic sensitivity were calculated.
  
  
  RESULTS
  BIS R0, circumference and volume detected swelling < 3.5% at D-1. The swelling at D2 and D8 was greater with BIS R0 [mean (SD) 29.9% (±9.8) and 38.27 (±7.8)] than with volume [14.7 (±9.5) and 14.9 (±8.2)] and circumference [11.1 (±5.7) and 11.7 (±4.1)]. The BIS R0 intra- and inter-evaluator ICCs ranged from 0.89 to 0.99, whereas the LOA were < 5.2%. The BIS R0 correlation was 0.73 with volume and 0.75 with circumference. The BIS R0 Cohen's d was 3.32 for the D-1-D2 evolution. The diagnostic sensitivity was 83% D2 and 96% at D8.
  
  
  CONCLUSIONS
  Bioimpedance is a valid method for the evaluation of swelling following TKA. BIS R0 also demonstrated excellent intra- and inter-evaluator reliability. The diagnostic sensitivity and responsiveness is superior to that of concurrent methods. BIS R0 is an efficient method for post-surgical follow up at the bedside of the patient. The measurement of BIS R0 is a straightforward, valid, reliable and responsive method for lower limb swelling following TKA surgery that could be used in clinics and research.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT00627770.
authors.affiliation: Physiotherapy Department, Haute Ecole de Santé Vaud (HESAV), HES-SO, University of Applied Sciences Western Switzerland, Delémont, Switzerland. claude.pichonnaz@hesav.ch.|CHUV-UNIL, Orthopedics and Traumatology Department, CHUV-UNIL, Avenue du Bugnon 21, 1011, Lausanne, Switzerland. claude.pichonnaz@hesav.ch.
authors.forename: Claude
authors.initials: C
authors.lastname: Pichonnaz
authors.affiliation: Physiotherapy Department, Haute Ecole de Santé Vaud (HESAV), HES-SO, University of Applied Sciences Western Switzerland, Delémont, Switzerland. jean-philippe.bassin@hesav.ch.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Bassin
authors.affiliation: CHUV-UNIL, direction médicale, Rue du Bugnon 46, 1011, Lausanne, Switzerland. Estelle.Lecureux@chuv.ch.
authors.forename: Estelle
authors.initials: E
authors.lastname: Lécureux
authors.affiliation: Physiotherapy Department, Haute Ecole de Santé Vaud (HESAV), HES-SO, University of Applied Sciences Western Switzerland, Delémont, Switzerland. Damien.currat@hesav.ch.
authors.forename: Damien
authors.initials: D
authors.lastname: Currat
authors.affiliation: CHUV-UNIL, Orthopedics and Traumatology Department, CHUV-UNIL, Avenue du Bugnon 21, 1011, Lausanne, Switzerland. Brigitte.Jolles-Haeberli@chuv.ch.
authors.forename: Brigitte M
authors.initials: BM
authors.lastname: Jolles
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D058266:Dielectric Spectroscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000473:pathology* / Q000601:surgery; D007866:Leg / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D020370:Osteoarthritis, Knee / Q000601:surgery*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome