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. 2024 Dec 16;36(1):46.
doi: 10.1186/s43019-024-00251-4.

Quantifying fluid retention following modern pain management in TKA: an observational study

Parkpoom Somrak  1   2   3 , Aree Tanavalee  4   5   6 , Srihatach Ngarmukos  2   3 , Chotetawan Tanavalee  2   3 , Chavarin Amarase  2   3 , Nonn Jaruthien  2   3 , Wirinaree Kampitak  7
Affiliations

Quantifying fluid retention following modern pain management in TKA: an observational study

Parkpoom Somrak et al. Knee Surg Relat Res. .

Abstract

Background: Body fluid retention after major surgeries, including total knee arthroplasty (TKA), is well documented in the literature. Currently, multimodal pain control protocols consisting of several medications together with early discharge protocol may magnify this adverse event after a patient's discharge. However, no study has focused on the quantitative and chronological changes in body fluids following modern pain management protocols for TKA. The aim of this study was to investigate the perioperative total body water (TBW) change in patient undergoing TKA.

Patients and methods: A consecutive series of 85 patients undergoing primary unilateral TKA, with uniform hospital admission, multimodal pain control, and rehabilitation protocol, had five consecutive multifrequency bioelectrical impedance analysis (BIA) scans; baseline, postoperative day 1 (POD 1), postoperative day 3 (POD 3), 2 weeks, and 6 weeks. Changes in TBW, body weight, corticosteroid-fluid retention dose-response relationship, and complications were evaluated.

Results: Seventy patients completed all five scans and follow-ups. Female patients were dominant, with a mean age of 69.5 years. There were no perioperative complications. At 24 h, the mean total fluid input and output were 3695.14 mL and 1983.43 mL, respectively, with 1711.71 mL increments and a mean accumulative dosage of dexamethasone of 15.14 mg. The mean TBW increased by 2.61 L on POD 1 and continued to peak at 3.2 L on POD 3, then gradually decreased at 2 weeks and reached the baseline level at 6 weeks postoperatively. Similarly, the mean body weight increased to 2.8 kg on POD 1, reached the maximum point at 3.42 kg on POD 3, and returned to baseline at 6 weeks.

Conclusions: Fluid retention following multimodal pain control in TKA increased from POD 1, peaked on POD 3, and gradually returned to the baseline at 6 weeks. With early discharge protocol, patient education regarding fluid retention after discharge should be considered.

Keywords: Body weight; Fluid balance; Fluid retention; TBW; TKA; Total body water; Total knee arthroplasty.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The institutional review board (IRB) of The Faculty of Medicine, Chulalongkorn University has approved this prospective observational study and consent (COA no. 1483/2023 IRB no. 0574/66). Consent for publication: All authors, who submitted the manuscript as shown below, understand that the information will be published without the full name of the authors attached but that full anonymity cannot be guaranteed. All authors understand that the text and any pictures or videos published in the article will be freely available on the internet and may be seen by the general public. The pictures, videos, and text may also appear on other websites or in print, be translated into other languages, or used for commercial purposes. Competing interests: All authors declare their competing interests as the following. (1) Royalties from a company or supplier: none. (2) Speakers bureau/paid presentations for a company or supplier: none. (3A) Paid employee for a company or supplier: none. (3B) Paid consultant for a company or supplier: none. (3C) Unpaid consultants for a company or supplier: none. (4) Stock or stock options in a company or supplier: none. (5) Research support from a company or supplier as a Principal Investigator: none. (6) Other financial or material support from a company or supplier: none. (7) Royalties, financial or material support from publishers: none. (8) Orthopedic publication editorial/governing board: none. (9) Board member/committee appointments for a society: none.

Figures

Fig. 1
Fig. 1
Flow diagram of participants screened and enrolled in the study
Fig. 2
Fig. 2
The mean ± standard deviation (SD) with a 95% confidence interval (CI) of total body water (TBW) showed significant changes from the baseline level (POD 0) on POD 1 and POD 3. It slowly decreased to the baseline level on POD 42
Fig. 3
Fig. 3
The mean ± standard deviation (SD) with a 95% confidence interval (CI) of body weight showed significant changes from the baseline level (POD 0) on POD 1 and POD 3. Similar to total body water (TBW) changes, it slowly decreased to the baseline level on POD 42
See this image and copyright information in PMC

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