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Abstract：
OBJECTIVE: Early ambulation is an important step in accelerating post-joint replacement surgery recovery. However, there is limited research on populations who are unable to walk immediately after the operation. The purpose of this study was to determine the factors influencing postoperative ambulation in total knee arthroplasty (TKA) patients.
METHODS: Primary TKA patients were included in this retrospective study. All patients were divided into two groups. Patients who began walking within 24 h were categorized as the early ambulation group, while patients who began walking after 24 h were classified as the late ambulation group. Recorded demographic data included age, gender, body mass index (BMI), clinical diagnosis, and comorbidities. Hematological parameters potentially affecting patients\' preoperative physical condition were also documented. Additionally, intraoperative metrics such as surgical time, surgical side, tourniquet time, intraoperative blood loss, the placement of drains, and prosthetic model were recorded.
RESULTS: A total of 453 patients (79.0% female, 21.0% male) were included in this study. The average age of all patients was 68.5±7.9 years, ranging from 36 to 87 years, with an average BMI of 27.2±9.9 kg/ m 2 . The mean postoperative ambulation time was 1.6 days, with a range of 0-4 days. In univariate group comparisons, an increase in postoperative time to ambulation was significantly associated with a history of heart disease ( P < 0.001 ), stroke history ( P = 0.003 ), and prior surgeries ( P = 0.003 ). Patients who delayed ambulation also exhibited significantly higher coagulation-related parameters including PT ( P < 0.001 ), APTT ( P = 0.002 ), TT ( P = 0.039 ) before surgery compared to those who mobilized early. Furthermore, prolonged surgical time ( P = 0.030 ), increased intraoperative blood loss ( P < 0.001 ), and the placement of intraoperative drains ( P < 0.001 ) also significantly extended the time to postoperative ambulation. However, after multivariate logistic regression analysis, only PT (OR 1.86, 95% CI 1.32 - 2.61, P < 0.001 ), TT (OR 1.30, 95% CI 1.09 - 1.55, P = 0.004 ) intraoperative blood loss (OR 1.01, 95% CI 1.00 - 1.01, P = 0.008 ) and the placement of intraoperative drains (OR 11.39, 95% CI 6.59 - 19.69, P < 0.001 ) were identified as predictive factors for late ambulation in patients after TKA.
CONCLUSIONS: In this study, preoperative coagulation function, intraoperative blood loss and the placement of intraoperative drains were factors contributing to delay ambulation time. Therefore, it is believed that properly improving preoperative coagulation function, effective intraoperative hemostasis, and reducing the placement of drains have a positive impact on early postoperative ambulation in patients undergoing TKA.
METHODS: Primary TKA patients were included in this retrospective study. All patients were divided into two groups. Patients who began walking within 24 h were categorized as the early ambulation group, while patients who began walking after 24 h were classified as the late ambulation group. Recorded demographic data included age, gender, body mass index (BMI), clinical diagnosis, and comorbidities. Hematological parameters potentially affecting patients\' preoperative physical condition were also documented. Additionally, intraoperative metrics such as surgical time, surgical side, tourniquet time, intraoperative blood loss, the placement of drains, and prosthetic model were recorded.
RESULTS: A total of 453 patients (79.0% female, 21.0% male) were included in this study. The average age of all patients was 68.5±7.9 years, ranging from 36 to 87 years, with an average BMI of 27.2±9.9 kg/ m 2 . The mean postoperative ambulation time was 1.6 days, with a range of 0-4 days. In univariate group comparisons, an increase in postoperative time to ambulation was significantly associated with a history of heart disease ( P < 0.001 ), stroke history ( P = 0.003 ), and prior surgeries ( P = 0.003 ). Patients who delayed ambulation also exhibited significantly higher coagulation-related parameters including PT ( P < 0.001 ), APTT ( P = 0.002 ), TT ( P = 0.039 ) before surgery compared to those who mobilized early. Furthermore, prolonged surgical time ( P = 0.030 ), increased intraoperative blood loss ( P < 0.001 ), and the placement of intraoperative drains ( P < 0.001 ) also significantly extended the time to postoperative ambulation. However, after multivariate logistic regression analysis, only PT (OR 1.86, 95% CI 1.32 - 2.61, P < 0.001 ), TT (OR 1.30, 95% CI 1.09 - 1.55, P = 0.004 ) intraoperative blood loss (OR 1.01, 95% CI 1.00 - 1.01, P = 0.008 ) and the placement of intraoperative drains (OR 11.39, 95% CI 6.59 - 19.69, P < 0.001 ) were identified as predictive factors for late ambulation in patients after TKA.
CONCLUSIONS: In this study, preoperative coagulation function, intraoperative blood loss and the placement of intraoperative drains were factors contributing to delay ambulation time. Therefore, it is believed that properly improving preoperative coagulation function, effective intraoperative hemostasis, and reducing the placement of drains have a positive impact on early postoperative ambulation in patients undergoing TKA.
摘要：
目的：早期下床活动是加速关节置换手术后恢复的重要步骤。然而,对手术后无法立即行走的人群的研究有限。本研究的目的是确定影响全膝关节置换术（TKA）患者术后下床活动的因素。
方法：本回顾性研究包括原发性TKA患者。将所有患者分为两组。在24小时内开始行走的患者被归类为早期行走组，而24小时后开始行走的患者被归类为晚期行走组。记录的人口统计数据包括年龄，性别,体重指数（BMI），临床诊断,和合并症。还记录了可能影响患者术前身体状况的血液学参数。此外,术中指标，如手术时间，手术侧，止血带时间,术中失血,排水沟的位置,并记录假体模型。
结果：共453例患者（79.0％为女性，21.0%男性)纳入本研究。所有患者的平均年龄为68.5±7.9岁,从36岁到87岁，平均BMI为27.2±9.9kg/m2。术后平均下床活动时间为1.6天，范围为0-4天。在单变量组比较中，术后下床活动时间的增加与心脏病史显着相关（P<0.001），卒中病史（P=0.003），和先前的手术（P=0.003）。延迟下床的患者也表现出明显较高的凝血相关参数，包括PT（P<0.001）。APTT（P=0.002），手术前的TT（P=0.039）与早期动员者相比。此外，手术时间延长（P=0.030），术中出血量增加（P<0.001），术中引流管的放置(P<0.001)也显著延长了术后下床活动时间。然而,经过多变量逻辑回归分析，仅PT（OR1.86，95%CI1.32-2.61，P<0.001），TT（OR1.30，95％CI1.09-1.55，P=0.004），术中失血量（OR1.01，95％CI1.00-1.01，P=0.008）和术中引流管的放置（OR11.39，95％CI6.59-19.69，P<0.001）被确定为TKA患者术后晚期下床活动的预测因素。
结论：在这项研究中，术前凝血功能,术中失血和术中引流管的放置是导致下床时间延迟的因素。因此,人们认为适当改善术前凝血功能，有效的术中止血，减少引流管的放置对TKA患者术后早期下床活动有积极影响。
方法：本回顾性研究包括原发性TKA患者。将所有患者分为两组。在24小时内开始行走的患者被归类为早期行走组，而24小时后开始行走的患者被归类为晚期行走组。记录的人口统计数据包括年龄，性别,体重指数（BMI），临床诊断,和合并症。还记录了可能影响患者术前身体状况的血液学参数。此外,术中指标，如手术时间，手术侧，止血带时间,术中失血,排水沟的位置,并记录假体模型。
结果：共453例患者（79.0％为女性，21.0%男性)纳入本研究。所有患者的平均年龄为68.5±7.9岁,从36岁到87岁，平均BMI为27.2±9.9kg/m2。术后平均下床活动时间为1.6天，范围为0-4天。在单变量组比较中，术后下床活动时间的增加与心脏病史显着相关（P<0.001），卒中病史（P=0.003），和先前的手术（P=0.003）。延迟下床的患者也表现出明显较高的凝血相关参数，包括PT（P<0.001）。APTT（P=0.002），手术前的TT（P=0.039）与早期动员者相比。此外，手术时间延长（P=0.030），术中出血量增加（P<0.001），术中引流管的放置(P<0.001)也显著延长了术后下床活动时间。然而,经过多变量逻辑回归分析，仅PT（OR1.86，95%CI1.32-2.61，P<0.001），TT（OR1.30，95％CI1.09-1.55，P=0.004），术中失血量（OR1.01，95％CI1.00-1.01，P=0.008）和术中引流管的放置（OR11.39，95％CI6.59-19.69，P<0.001）被确定为TKA患者术后晚期下床活动的预测因素。
结论：在这项研究中，术前凝血功能,术中失血和术中引流管的放置是导致下床时间延迟的因素。因此,人们认为适当改善术前凝血功能，有效的术中止血，减少引流管的放置对TKA患者术后早期下床活动有积极影响。
