Perioperative hemorheological status of oncological patients with primary knee replacement

Introduction. Endoprosthesis of large joints is associated with high risk of venous thromboembolism. Researchers focus on biochemical characteristics of homeostasis, blood clotting in particular, as the main reason for abnormal blood flow. At the same time, biophysical condition of homeostasis, namely decreased blood fluidity, is rarely considered. Study of rheological behavior of blood after primary oncological endoprosthesis of large joints in patients can potentially affect the selection of perioperative thromboprophylaxis and patient rehabilitation approach.

Aim. To study the indicators of the hemorheological status of patients with tumours of long bones in the preand postoperative periods of primary oncological knee replacement.

Materials and methods. The study included 36 patients (26 men and 10 women, mean age 46 years) without cardiovascular diseases and pathology of the veins of the lower limb admitted to the Russian Scientific Center of Roentgen Radiology for oncological endoprosthesis of the knee joint. All patients were prescribed: an antiplatelet agent (acetylsalicylic acid) and an anticoagulant (enoxaparin sodium 40 mg daily). Distal resection of the femur (on average 14 cm) was performed in 28 patients, and proximal resection of the tibia (on average 12 cm) in 8 patients, followed by knee replacement. Before the operation, on the 1st and 6th days after the operation, the hemorheological status and the state of the hemostasis system were evaluated in all patients. To determine the reference values, 24 healthy people were examined, comparable in gender and age. Statistical analysis using Statistica 10.0.

Results. During the preoperative examination, integral assessment showed the differences in the severity of hemorheological disorders between patients, and two groups were identified: Group 1 – 21 (61 %) patients whose hemorheological disorders were classified as severity degree I, and Group 2 – 14 (39 %) patients with severity degree II d. On day 1 after the surgery, both patient groups showed negative dynamics: hemorheological disorders in group 1 worsened from grade I to II d., and in group 2 to III d. (critical) (p <0.05). On day 6, the parameters did not change significantly in all patients. Similar dynamic changes were observed in the haemostasis system.

Conclusion. Activation of the blood coagulation system and deterioration of hemorheology occurred after surgery during administration of anticoagulant and antiplatelet therapy. None of the patients had venous thromboembolic complications, however the risk of their development remained high. A differential model describing hemorheological status can be useful for selection of thromboprophylaxis and rehabilitation methods which include physical factors that improve the hemorheological profile: low-frequency magnetic and/or laser therapy in patients.

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