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

Claude Pichonnaz, Jean-Philippe Bassin, Estelle Lécureux, Damien Currat, Brigitte M Jolles, Claude Pichonnaz, Jean-Philippe Bassin, Estelle Lécureux, Damien Currat, Brigitte M Jolles

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.

Conclusion: 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.

Trial registration: ClinicalTrials.gov Identifier: NCT00627770.

Figures

Figure 1
Figure 1
Comparison of swelling evolution according to the measurement method. Legend: black line: mean BIS R0, red’ line: mean volume, blue line: mean knee circumference, bars: standard deviation.

References

    1. AAOS. Arthritis and related conditions. Rosemont IL: American Academy of Orthopaedic Surgeons. 2008 [updated 5th March 2009], p. 71–96. Available from: [.
    1. Crosbie J, Naylor J, Harmer A, Russell T. Predictors of functional ambulation and patient perception following total knee replacement and short-term rehabilitation. Disabil Rehabil. 2010;32(13):1088–98. doi: 10.3109/09638280903381014.
    1. Jones C, Voaklander D, Suarez-Almazor M. Determinants of function after total knee arthroplasty. Phys Ther. 2003;83(8):696.
    1. Briard JL, Gérémy F, Witoolkollachit P, Zahlaoui J. Surveillance des prothèses totales de genou. In: Bonnin M, Chambat P, editors. La gonarthrose. Paris: Springer; 2003. pp. 307–16.
    1. Bonnin M, Westphal M, Jacquemard C, Biot V, Giroud A, Mathelin J, et al. Rééducation après prothèse totale de genou. In: Bonnin M, Chabat P, et al., editors. La gonarthrose. Paris: Springer; 2003. pp. 317–22.
    1. Noble PC, Conditt MA, Cook KF, Mathis KB. The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res. 2006;452:35–43. doi: 10.1097/01.blo.0000238825.63648.1e.
    1. Freiling D, Lobenhoffer P. [The surgical treatment of chronic extension deficits of the knee. Oper Orthop Traumatol. 2009;21(6):545–56. doi: 10.1007/s00064-009-2004-0.
    1. Chesler E, Lariviere W, Zhen L, Shang G, Chen Y, Yu Y, et al. Correlations between edema and the immediate and prolonged painful consequences of inflammation: therapeutic implications? Acta Physiologica Sinica. 2005;57(3):278–88.
    1. O’Driscoll S, Giori N. Continuous passive motion (CPM): theory and principles of clinical application. J Rehabil Res Dev. 2000;37(2):179.
    1. Torry M, Decker M, Viola R, O’Connor D, Richard SJ. Intra-articular knee joint effusion induces quadriceps avoidance gait patterns. Clin Biomechanics. 2000;15(3):147–59. doi: 10.1016/S0268-0033(99)00083-2.
    1. Holm B, Kristensen MT, Bencke J, Husted H, Kehlet H, Bandholm T. Loss of knee-extension strength is related to knee Swellin0g after total knee arthroplasty. Arch Phys Med Rehabil. 2010;91(11):1770–6. doi: 10.1016/j.apmr.2010.07.229.
    1. Hopkins J, Ingersoll C, Edwards J, Klootwyk T. Cryotherapy and transcutaneous electric neuromuscular stimulation decrease arthrogenic muscle inhibition of the vastus medialis after knee joint effusion. J Athl Train. 2001;37(1):25.
    1. Bizzini M, Boldt J, Munzinger U, Drobny T. Rehabilitationsrichtlinien nach Knieendoprothesen. Orthopade. 2003;32(6):527–34.
    1. Napier RJ, Bennett D, McConway J, Wilson R, Sykes AM, Doran E, et al. The influence of immediate knee flexion on blood loss and other parameters following total knee replacement. Bone Joint J. 2014;96-B(2):201–9. doi: 10.1302/0301-620X.96B2.32787.
    1. Li B, Wen Y, Liu D, Tian L. The effect of knee position on blood loss and range of motion following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2012;20(3):594–9. doi: 10.1007/s00167-011-1628-4.
    1. Ebert JR, Joss B, Jardine B, Wood DJ. Randomized trial investigating the efficacy of manual lymphatic drainage to improve early outcome after total knee arthroplasty. Arch Phys Med Rehabil. 2013;94(11):2103–11. doi: 10.1016/j.apmr.2013.06.009.
    1. Adravanti P, Nicoletti S, Setti S, Ampollini A, de Girolamo L. Effect of pulsed electromagnetic field therapy in patients undergoing total knee arthroplasty: a randomised controlled trial. Int Orthop. 2014;38(2):397–403. doi: 10.1007/s00264-013-2216-7.
    1. Moretti B, Notarnicola A, Moretti L, Setti S, De Terlizzi F, Pesce V, et al. I-ONE therapy in patients undergoing total knee arthroplasty: a prospective, randomized and controlled study. BMC Musculoskelet Disord. 2012;13(1):88. doi: 10.1186/1471-2474-13-88.
    1. Su EP, Perna M, Boettner F, Mayman DJ, Gerlinger T, Barsoum W, et al. A prospective, multi-center, randomised trial to evaluate the efficacy of a cryopneumatic device on total knee arthroplasty recovery. J Bone Joint Surg Br Volume. 2012;94-B(11 Suppl):153–6. doi: 10.1302/0301-620X.94B11.30832.
    1. Demoulin C, Brouwers M, Darot S, Gillet P, Crielaard JM, Vanderthommen M. Comparison of gaseous cryotherapy with more traditional forms of cryotherapy following total knee arthroplasty. Ann Physical Rehab Med. 2012;55(4):229–40. doi: 10.1016/j.rehab.2012.03.004.
    1. Munk S, Jensen NJ, Andersen I, Kehlet H, Hansen TB. Effect of compression therapy on knee swelling and pain after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2013;21(2):388–92. doi: 10.1007/s00167-012-1963-0.
    1. Ediz L, Ceylan MF, Turktas U, Yanmis I, Hiz O. A randomized controlled trial of electrostimulation effects on effusion, swelling and pain recovery after anterior cruciate ligament reconstruction: a pilot study. Clin Rehabil. 2012;26(5):413–22. doi: 10.1177/0269215511421029.
    1. Windisch C, Kolb W, Kolb K, Grützner P, Venbrocks R, Anders J. Pneumatic compression with foot pumps facilitates early postoperative mobilisation in total knee arthroplasty. Int Orthop. 2011;35(7):995–1000. doi: 10.1007/s00264-010-1091-8.
    1. Soderberg GL, Ballantyne BT, Kestel LL. Reliability of lower extremity girth measurements after anterior cruciate ligament reconstruction. Physiother Res Int. 1996;1(1):7–16. doi: 10.1002/pri.43.
    1. Meier W, Mizner RL, Marcus RL, Dibble LE, Peters C, Lastayo PC. Total knee arthroplasty: muscle impairments, functional limitations, and recommended rehabilitation approaches. J Orthop Sports Phys Ther. 2008;38(5):246–56. doi: 10.2519/jospt.2008.2715.
    1. Sitzia J. Volume measurement in lymphoedema treatment: examination of formulae. Eur J Cancer Care (Engl) 1995;4(1):11–6. doi: 10.1111/j.1365-2354.1995.tb00047.x.
    1. Megens A, Harris S, Kim-Sing C, McKenzie D. Measurement of upper extremity volume in women after axillary dissection for breast cancer. Arch Phys Med Rehabil. 2001;82(12):1639–44. doi: 10.1053/apmr.2001.26822.
    1. Meijer RS, Rietman JS, Geertzen JH, Bosmans JC, Dijkstra PU. Validity and intra- and interobserver reliability of an indirect volume measurements in patients with upper extremity lymphedema. Lymphology. 2004;37(3):127–33.
    1. Taylor R, Jayasinghe U, Koelmeyer L, Ung O, Boyages J. Reliability and validity of arm volume measurements for assessment of lymphedema. Phys Ther. 2006;86(2):205.
    1. Perrin M, Guex JJ. Edema and leg volume: methods of assessment. Angiology. 2000;51(1):9–12. doi: 10.1177/000331970005100103.
    1. Warren A, Brorson H, Borud L, Slavin S. Lymphedema: a comprehensive review. Ann Plast Surg. 2007;59(4):464. doi: 10.1097/01.sap.0000257149.42922.7e.
    1. Ward LC, Czerniec S, Kilbreath SL. Quantitative bioimpedance spectroscopy for the assessment of lymphoedema. Breast Cancer Res Treat. 2009;117(3):541–7. doi: 10.1007/s10549-008-0258-0.
    1. Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Gomez JM, et al. Bioelectrical impedance analysis–part I: review of principles and methods. Clin Nutr. 2004;23(5):1226–43. doi: 10.1016/j.clnu.2004.06.004.
    1. Watanabe R, Kotoura H, Morishita Y. CT analysis of the use of the electrical impedance technique to estimate local oedema in the extremities in patients with lymphatic obstruction. Med Biol Eng Comput. 1998;36(1):60–5. doi: 10.1007/BF02522859.
    1. Pichonnaz C, Bassin JP, Currat D, Martin E, Jolles BM. Bioimpedance for oedema evaluation after total knee arthroplasty. Physiother Res Int. 2013;18(3):140–7. doi: 10.1002/pri.1540.
    1. Ward LC. Bioelectrical impedance analysis: proven utility in lymphedema risk assessment and therapeutic monitoring. Lymphat Res Biol. 2006;4(1):51–6. doi: 10.1089/lrb.2006.4.51.
    1. Moseley A, Piller N, Carati C. Combined opto-electronic perometry and bioimpedance to measure objectively the effectiveness of a new treatment intervention for chronic secondary leg lymphedema. Lymphology. 2002;35(4):136–43.
    1. Ward LC, Czerniec S, Kilbreath SL. Operational equivalence of bioimpedance indices and perometry for the assessment of unilateral arm lymphedema. Lymphat Res Biol. 2009;7(2):81–5. doi: 10.1089/lrb.2008.1027.
    1. King RJ, Clamp JA, Hutchinson JW, Moran CG. Bioelectrical impedance: a new method for measuring post-traumatic swelling. J Orthop Trauma. 2007;21(7):462–8. doi: 10.1097/BOT.0b013e318123e88a.
    1. Cornish BH, Chapman M, Hirst C, Mirolo B, Bunce IH, Ward LC, et al. Early diagnosis of lymphedema using multiple frequency bioimpedance. Lymphology. 2001;34(1):2–11.
    1. Hayes S, Janda M, Cornish B, Battistutta D, Newman B. Lymphedema secondary to breast cancer: how choice of measure influences diagnosis, prevalence, and identifiable risk factors. Lymphology. 2008;41(1):18.
    1. Ward LC, Dylke E, Czerniec S, Isenring E, Kilbreath SL. Reference ranges for assessment of unilateral lymphedema in legs by bioelectrical impedance spectroscopy. Lymphat Res Biol. 2011;9(1):43–6. doi: 10.1089/lrb.2010.0024.
    1. Portney LG, Watkins MP. Foundations of clinical research: application to practice. 3. Upper Saddle River: Prentice Hall; 2009.
    1. Mehrotra C, Remington PL, Naimi TS, Washington W, Miller R. Trends in total knee replacement surgeries and implications for public health, 1990–2000. Public Health Rep. 2005;120(3):278–82.
    1. Jolles BM, Grzesiak A, Eudier A, Dejnabadi H, Voracek C, Pichonnaz C, et al. A randomised controlled clinical trial and gait analysis of fixed- and mobile-bearing total knee replacements with a five-year follow-up. J Bone Joint Surg (Br) 2012;94(5):648–55. doi: 10.1302/0301-620X.94B5.27598.
    1. Cornish BH, Bunce IH, Ward LC, Jones LC, Thomas BJ. Bioelectrical impedance for monitoring the efficacy of lymphoedema treatment programmes. Breast Cancer Res Treat. 1996;38(2):169–76. doi: 10.1007/BF01806671.
    1. Czerniec SA, Ward LC, Refshauge KM, Beith J, Lee MJ, York S, et al. Assessment of breast cancer-related arm lymphedema—comparison of physical measurement methods and self-report. Cancer Investig. 2010;28(1):54–62. doi: 10.3109/07357900902918494.
    1. Bulley C, Coutts F, Tan CW. Perometry limb volume measurement: protocol development and reliability. Eur J Physiother. 2013;15(4):193–200. doi: 10.3109/21679169.2013.831482.
    1. Mizner RL, Petterson SC, Stevens JE, Vandenborne K, Snyder-Mackler L. Early quadriceps strength loss after total knee arthroplasty: the contributions of muscle atrophy and failure of voluntary muscle activation. J Bone Joint Surg Am. 2005;87(5):1047–53. doi: 10.2106/JBJS.D.01992.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir