Analysis of correlation between Barthel index score and preoperative occurrence of deep vein thrombosis in patients undergoing total hip arthroplasty revision surgery_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SHEN Ying ^1,2 , YAO Yao ^1,2 , QIAO Liang ^1,2 , WU Dengxian ^1,2 , LI Xinhua ^1,2 ,  JIANG Qing ^1,2

1. Department of Orthopedics, Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, 210008, P. R. China;
2. Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing Jiangsu, 210008, P. R. China;

Corresponding author：

JIANG Qing, Email: jiangqing112@hotmail.com

Keywords：

Barthel index score; total hip arthroplasty; deep vein thrombosis of lower extremity; revision surgery

DOI：

10.7507/1002-1892.202409075

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Objective To explore the correlation between the Barthel index score and other factors with the preoperative occurrence of deep vein thrombosis (DVT) in patients undergoing total hip arthroplasty (THA) revision surgery. Methods A retrospective analysis was conducted on clinical data from 122 patients who met the inclusion criteria and underwent THA revision surgery between April 2017 and November 2020. Among them, 61 were male and 61 were female, with an age range of 32-85 years (mean, 65.3 years). The reasons for revision included prosthetic joint infection in 7 cases, periprosthetic fracture in 4 cases, prosthetic dislocation in 6 cases, and aseptic loosening in 105 cases. The Barthel index score was 76.4±17.7, with 10 cases classified as level 1, 57 as level 2, 37 as level 3, and 18 as level 4. Univariate analysis was performed on variables such as age, gender, body mass index, Barthel index score, preoperative D-dimer positivity, history of diabetes, hypertension, cancer, cerebral infarction, smoking, and thrombosis in patients with and without preoperative DVT. Furthermore, logistic regression was used to identify risk factors for preoperative DVT in THA revision surgery. The incidence of preoperative DVT was compared among different Barthel index score groups. Results Preoperative DVT was detected in 11 patients (9.02%), all of whom had intermuscular venous thrombosis. Among them, 1 had prosthetic joint infection, 1 had periprosthetic fracture, 1 had prosthetic dislocation, and 8 had aseptic loosening. Univariate analysis showed significant differences between the two groups in terms of age, gender, and Barthel index score (P<0.05). logistic regression further revealed that female, age ≥70 years, and Barthel index score<60 were independent risk factors for preoperative DVT in patients undergoing THA revision surgery (P<0.05). The incidence of preoperative DVT in patients with Barthel index scores of levels 1, 2, 3, and 4 were 0 case (0%), 2 cases (3.5%), 3 cases (8.1%), and 6 cases (33.3%), respectively. A significant correlation was found between Barthel index score classification and the incidence of preoperative DVT in patients undergoing THA revision surgery (χ²=10.843, P=0.001). Conclusion In patients undergoing THA revision surgery, older age, female, and lower Barthel index scores are associated with higher preoperative DVT incidence. For patients with low preoperative Barthel index scores, preoperative thrombosis screening should be emphasized.

Citation： SHEN Ying, YAO Yao, QIAO Liang, WU Dengxian, LI Xinhua, JIANG Qing. Analysis of correlation between Barthel index score and preoperative occurrence of deep vein thrombosis in patients undergoing total hip arthroplasty revision surgery. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(2): 158-162. doi: 10.7507/1002-1892.202409075 Copy

1.	Schwartz BE, Piponov HI, Helder CW, et al. Revision total hip arthroplasty in the United States: national trends and in-hospital outcomes. Int Orthop, 2016, 40(9): 1793-1802.
2.	Kahlenberg CA, Swarup I, Krell EC, et al. Causes of revision in young patients undergoing total hip arthroplasty. J Arthroplasty, 2019, 34(7): 1435-1440.
3.	顾建明, 冯啸, 周一新. 1422例人工髋关节翻修术病因分析. 中华骨与关节外科杂志, 2021, 14(4): 267-271.
4.	Pandey AK, Zuke WA, Surace P, et al. Management of acetabular bone loss in revision total hip replacement: a narrative literature review. Ann Jt, 2023, 9: 21. doi: 10.21037/aoj-23-23.
5.	Kawai T, Goto K, Kuroda Y, et al. Lower activity and function scores are associated with a higher risk of preoperative deep venous thrombosis in patients undergoing total hip arthroplasty. J Clin Med, 2020, 9(5): 1257. doi: 10.3390/jcm9051257.
6.	Kageyama N, Ro A, Tanifuji T, et al. Significance of the soleal vein and its drainage veins in cases of massive pulmonary thromboembolism. Ann Vasc Dis, 2008, 1(1): 35-39.
7.	Sachdeva A, Dalton M, Lees T. Graduated compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev, 2018, 11(11): CD001484. doi: 10.1002/14651858.CD001484.pub4.
8.	Wakabayashi H, Hasegawa M, Niimi R, et al. Clinical analysis of preoperative deep vein thrombosis risk factors in patients undergoing total hip arthroplasty. Thromb Res, 2015, 136(5): 855-858.
9.	Wu JX, Qing JH, Yao Y, et al. Performance of age-adjusted D-dimer values for predicting DVT before the knee and hip arthroplasty. J Orthop Surg Res, 2021, 16(1): 82. doi: 10.1186/s13018-020-02172-w.
10.	Xu K, Chan NC, Ibrahim Q, et al. Reduction in mortality following elective major hip and knee surgery: A systematic review and meta-analysis. Thromb Haemost, 2019, 119(4): 668-674.
11.	Akram F, Fan BE, Tan CW, et al. The clinical application of venous ultrasound in diagnosis and follow-up of lower extremity deep vein thrombosis (DVT): a case-based discussion. Thromb J, 2023, 21(1): 110. doi: 10.1186/s12959-023-00550-y.
12.	Chen Z, Sax OC, Bains SS, et al. Super-obese patients are associated with significant infection burden after total hip arthroplasty. Hip Int, 2023, 33(5): 806-811.
13.	Zhou L, Feng C, Lu Y, et al. Development and validation of health-oriented personal evaluation for the community-dwelling older person based on the International Classification of Functioning, Disability and Health. Int J Older People Nurs, 2024, 19(3): e12609. doi: 10.1111/opn.12609.
14.	Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest, 2008, 133(6 Suppl): 381S-453S.
15.	Piovella F, Wang CJ, Lu H, et al. Deep-vein thrombosis rates after major orthopedic surgery in Asia. An epidemiological study based on postoperative screening with centrally adjudicated bilateral venography. J Thromb Haemost, 2005, 3(12): 2664-2670.
16.	Strini V, Piazzetta N, Gallo A, et al. Barthel Index: creation and validation of two cut-offs using the BRASS Index. Acta Biomed, 2020, 91(2-S): 19-26.
17.	Hoyer EH, Bhave A, Xue W, et al. Inaccuracy of initial clinical mobility assessment in venous thromboembolism risk stratification. Am J Med, 2024, 137(8): 776-781.
18.	Zhang ZH, Shen B, Yang J, et al. Risk factors for venous thromboembolism of total hip arthroplasty and total knee arthroplasty: a systematic review of evidences in ten years. BMC Musculoskelet Disord, 2015, 16: 24. doi: 10.1186/s12891-015-0470-0.
19.	Abe K, Yuda S, Yasui K, et al. Soleal vein dilatation assessed by ultrasonography is an independent predictor for deep vein thrombosis after major orthopedic surgery. J Cardiol, 2017, 69(5): 756-762.
20.	Tornero-Quiñones I, Sáez-Padilla J, Espina Díaz A, et al. Functional ability, frailty and risk of falls in the elderly: relations with autonomy in daily living. Int J Environ Res Public Health, 2020, 17(3): 1006. doi: 10.3390/ijerph17031006.

1. Schwartz BE, Piponov HI, Helder CW, et al. Revision total hip arthroplasty in the United States: national trends and in-hospital outcomes. Int Orthop, 2016, 40(9): 1793-1802.
2. Kahlenberg CA, Swarup I, Krell EC, et al. Causes of revision in young patients undergoing total hip arthroplasty. J Arthroplasty, 2019, 34(7): 1435-1440.
3. 顾建明, 冯啸, 周一新. 1422例人工髋关节翻修术病因分析. 中华骨与关节外科杂志, 2021, 14(4): 267-271.
4. Pandey AK, Zuke WA, Surace P, et al. Management of acetabular bone loss in revision total hip replacement: a narrative literature review. Ann Jt, 2023, 9: 21. doi: 10.21037/aoj-23-23.
5. Kawai T, Goto K, Kuroda Y, et al. Lower activity and function scores are associated with a higher risk of preoperative deep venous thrombosis in patients undergoing total hip arthroplasty. J Clin Med, 2020, 9(5): 1257. doi: 10.3390/jcm9051257.
6. Kageyama N, Ro A, Tanifuji T, et al. Significance of the soleal vein and its drainage veins in cases of massive pulmonary thromboembolism. Ann Vasc Dis, 2008, 1(1): 35-39.
7. Sachdeva A, Dalton M, Lees T. Graduated compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev, 2018, 11(11): CD001484. doi: 10.1002/14651858.CD001484.pub4.
8. Wakabayashi H, Hasegawa M, Niimi R, et al. Clinical analysis of preoperative deep vein thrombosis risk factors in patients undergoing total hip arthroplasty. Thromb Res, 2015, 136(5): 855-858.
9. Wu JX, Qing JH, Yao Y, et al. Performance of age-adjusted D-dimer values for predicting DVT before the knee and hip arthroplasty. J Orthop Surg Res, 2021, 16(1): 82. doi: 10.1186/s13018-020-02172-w.
10. Xu K, Chan NC, Ibrahim Q, et al. Reduction in mortality following elective major hip and knee surgery: A systematic review and meta-analysis. Thromb Haemost, 2019, 119(4): 668-674.
11. Akram F, Fan BE, Tan CW, et al. The clinical application of venous ultrasound in diagnosis and follow-up of lower extremity deep vein thrombosis (DVT): a case-based discussion. Thromb J, 2023, 21(1): 110. doi: 10.1186/s12959-023-00550-y.
12. Chen Z, Sax OC, Bains SS, et al. Super-obese patients are associated with significant infection burden after total hip arthroplasty. Hip Int, 2023, 33(5): 806-811.
13. Zhou L, Feng C, Lu Y, et al. Development and validation of health-oriented personal evaluation for the community-dwelling older person based on the International Classification of Functioning, Disability and Health. Int J Older People Nurs, 2024, 19(3): e12609. doi: 10.1111/opn.12609.
14. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest, 2008, 133(6 Suppl): 381S-453S.
15. Piovella F, Wang CJ, Lu H, et al. Deep-vein thrombosis rates after major orthopedic surgery in Asia. An epidemiological study based on postoperative screening with centrally adjudicated bilateral venography. J Thromb Haemost, 2005, 3(12): 2664-2670.
16. Strini V, Piazzetta N, Gallo A, et al. Barthel Index: creation and validation of two cut-offs using the BRASS Index. Acta Biomed, 2020, 91(2-S): 19-26.
17. Hoyer EH, Bhave A, Xue W, et al. Inaccuracy of initial clinical mobility assessment in venous thromboembolism risk stratification. Am J Med, 2024, 137(8): 776-781.
18. Zhang ZH, Shen B, Yang J, et al. Risk factors for venous thromboembolism of total hip arthroplasty and total knee arthroplasty: a systematic review of evidences in ten years. BMC Musculoskelet Disord, 2015, 16: 24. doi: 10.1186/s12891-015-0470-0.
19. Abe K, Yuda S, Yasui K, et al. Soleal vein dilatation assessed by ultrasonography is an independent predictor for deep vein thrombosis after major orthopedic surgery. J Cardiol, 2017, 69(5): 756-762.
20. Tornero-Quiñones I, Sáez-Padilla J, Espina Díaz A, et al. Functional ability, frailty and risk of falls in the elderly: relations with autonomy in daily living. Int J Environ Res Public Health, 2020, 17(3): 1006. doi: 10.3390/ijerph17031006.

Chinese Journal of Reparative and Reconstructive Surgery

Analysis of correlation between Barthel index score and preoperative occurrence of deep vein thrombosis in patients undergoing total hip arthroplasty revision surgery

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