Bioimpedance spectroscopy for swelling evaluation following total knee arthroplasty: a validation study

Abstract

BackgroundThe 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.MethodsThe 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.ResultsBIS 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.ConclusionBioimpedance 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.Trial registrationClinicalTrials.gov Identifier: NCT00627770.

Early Unpleasant Postoperative Symptoms for Patients Undergoing Primary Hip versus Primary Knee Replacement: Patient Perception

“…In the same line come, Vikki Wylde, Livesey, and Blom (2012) who interviewed 60 knee and 56 hip replacement patients about their leisure activities, About one-third of TKR patients have reported difficult to perform leisure activities at 1 year following surgery while only quarter of THR patients have reported difficult to perform leisure activities at 1 year following surgery [49] . In addition, the findings of the result agreed with Pichonnaz, Bassin, Lécureux, Currat, and Jolles (2015) who reported that TKR patients experience swelling postoperatively while there are no research findings documented swelling as a health problem for THR patients [50] . The present study indicated that were statistically significant differences in the range of motion, pain level, and functional activities between the 4 th and 10 th postoperative day.…”

Should compression bandage be performed after total knee arthroplasty? A meta-analysis of randomized controlled trials

“…3 Forest plots of the included studies comparing post-operative pain [19]. Conversely, Pichonnaz et al noted massive swelling after TKA within the first 2 days without using of compression bandage [26]. Our metaanalysis found no significant difference in postoperative swelling whether using the compression bandage or not.…”

The increase in hydric volume is associated to contractile impairment in the calf after the world’s most extreme mountain ultra-marathon

“…Bioimpedance spectroscopy has been validated to measure oedema in lower limb [ 22 ]. Moreover, this method has been considered a reliable and responsive method to measure lower limb swelling [ 23 ]. In addition, the multi-frequency impedance meter used in our study (i.e.…”

“…Z-métrix ® ) was validated to measure water volumes, in standing and supine position, and independently to determine total and, extra- and intracellular water compartments [ 24 ]. As previously described, we measured the circumference of the thigh and the calf with a no-stretch tape which is a suitable method to display a non-significant difference, as well as excellent correlations with the volume determined by water displacement [ 23 ]. The circumference of the thigh was measured at ¾ʺ above the patella and at 11¾ʺ above the patella.…”