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The specific appearance of venous thrombosis following total hip replacement was analysed by reviewing 45 positive phlebograms from 122 patients participating in a concurrent trial against thromboembolism. Almost all thrombi were asymptomatic and non-occlusive. Forty-four per cent of the thrombi were excusively confined to the calf. The muscular veins were the most common location, followed by the fibular and posterior tibial veins. Ipsilateral thrombi predominated over thrombi in the non-operated leg. Thirty-six per cent were located in the ipsilateral thigh and the major part was found in the proximal part of the femoral veins. Nearly all were related to valve cusps, free-floating and were of small size. In 20 per cent, thrombi were found in both the calf and the thigh. Neither contralateral thigh thrombi, nor pelvic thrombi were found. Of 25 patients with pulmonary embolism, all but 3 asymptomatic, 64 per cent had thigh thrombi. A multifocallocation of thrombi was present but two major types of thrombosis were distinguished; calf vein thrombosis probably due to venous stasis and femoral thrombosis caused by the local surgical trauma.

SummaryPatients (n = 1600) from 12 European countries, scheduled for elective orthopaedic hip or knee surgery, were screened for Factor V Leiden and prothrombin gene G20210A mutations, found in 5.5% and 2.9% of the populations, respectively. All patients underwent prophylactic treatment with one of four doses of melagatran and ximelagatran or dalteparin, starting pre-operatively. Bilateral ascending venography was performed on study day 8-11. The patients were subsequently treated according to local routines and followed for 4-6 weeks postoperatively. The composite endpoint of screened deep vein thrombosis (DVT) and symptomatic pulmonary embolism (PE) during prophylaxis did not differ significantly between patients with or without these mutations. Symptomatic venous thromboembolism (VTE) during prophylaxis and follow-up (1.9%) was significantly over-represented among patients with the prothrombin gene G20210A mutation (p = 0.0002). A tendency towards increased risk of VTE was found with the Factor V Leiden mutation (p = 0.09). PE were few, but significantly over-represented in both the Factor V Leiden and prothrombin gene G20210A mutated patients (p = 0.03 and p = 0.05, respectively). However, since 90% of the patients with these genetic risk factors will not suffer a VTE event, a general pre-operative genotyping is, in our opinion, of questionable value.

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