Haemodynamic assessment in simulated operative positions before knee arthroplasty can be useful in deep vein thrombosis prediction

Hadžimehmedagić, Amel; Gavrankapetanović, Ismet; Vranić, Haris; Šunje, Mensur; Gavrankapetanović, Faris; Papović, Adnan; Granov, Nermir; Begovic, Begler; Omerović, Ðemil

doi:10.1007/s00264-015-2837-0

Cited by 2 publications

(4 citation statements)

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“…Total knee arthroplasty (TKA): A Doppler ultrasound study conducted intraoperatively before a TKA procedure found that calf venous blood flow was significantly reduced with knee flexion of at least 90 o , and that postoperative DVT (especially proximal DVT) occurred more commonly in patients with the lowest preoperative venous flow velocity after knee flexion 564 . The authors concluded that marked knee flexion during TKA reduced venous blood flow and may have increased DVT risk.…”

Section: - Does the Intra-operative Positioning Of A Patient Undergoi...mentioning

confidence: 99%

Recommendations from the ICM-VTE: General

2022

Journal of Bone and Joint Surgery

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Section: - Does the Intra-operative Positioning Of A Patient Undergoi...mentioning

confidence: 99%

Recommendations from the ICM-VTE: General

2022

Journal of Bone and Joint Surgery

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“…Wensing at al 18 reported magnetic resonance angiographic findings of age-related conformational change from smooth curvature at lower knee flexion angles to relative tortuosity at higher flexion angles for the popliteal artery and stated their concern for a comparable deformity of the popliteal vein by anatomical association. Hadžimehmedagić et al 7 demonstrated that the deep knee flexion angles required to perform total knee arthroplasty caused a disproportionate obstruction to popliteal venous flow through the tibial vein and hypothesized a vessel deformation mechanism at this extreme angle.…”

Section: Discussionmentioning

confidence: 99%

“…4-6 Beyond 30° to 60° of knee flexion, however, venous flow obstruction again increases in relation to the degree of flexion, exhibiting a large effect size. 7…”

Section: Introductionmentioning

confidence: 99%

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Pedal Musculovenous Pump Activation Effectively Counteracts Negative Impact of Knee Flexion on Human Popliteal Venous Flow

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Griend

et al. 2021

Foot & Ankle Specialist

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Knee scooters are commonly used for mobility instead of other devices. However, passive popliteal venous flow impedance has been observed with knee scooter usage ostensibly as a result of deep knee flexion. This study aimed to characterize the magnitude of impact knee flexion has on popliteal venous flow in relation to the degree of knee flexion when walking boot immobilized. Furthermore, the countervailing effect of standardized pedal musculovenous pump (PMP) activation was observed. Popliteal venous diameter and flow metrics were assessed with venous ultrasonography in 24 healthy individuals. Straight leg, crutch, and knee scooter positioning while wearing a walking boot and non–weight-bearing were compared. Flow was assessed with muscles at rest and with PMP activation. Of 24 participants, 16 (67%) were female. Twelve limbs (50%) were right sided. The mean age was 21.9 (SD = 3.0) years, and the mean body mass index was 21.9 (SD 1.9) kg/m2. Observer consistencies were excellent (intraclass correlation range = 0.93 to 0.99). No significant differences in mean vessel diameter, time-averaged mean velocity, and total volume flow occurred (all P > .01). Corresponding knee flexion effect sizes were small (range = −0.04 to −0.26). A significant decrease (−24%) in active median time-averaged peak velocity occurred between upright and crutch positions (20.89 vs 15.92 cm/s; P < .001) with a medium effect size (−0.51). PMP activation increased all flow parameters (all P < .001), and effect sizes were comparatively larger (>0.6) across all knee flexion positions. Clinical Significance: Knee flexion has a small to medium impact on popliteal venous return in healthy patients. Active toe motion effectively counters the negative effects of gravity and knee flexion when the ankle is immobilized. Levels of Evidence: Therapeutic, Level IV

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Haemodynamic assessment in simulated operative positions before knee arthroplasty can be useful in deep vein thrombosis prediction

Cited by 2 publications

References 5 publications

Recommendations from the ICM-VTE: General

Recommendations from the ICM-VTE: General

Pedal Musculovenous Pump Activation Effectively Counteracts Negative Impact of Knee Flexion on Human Popliteal Venous Flow

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