IntroductionThe number of total hip and total knee replacement procedures performed worldwide has tended to surge in recent years, due to the combination of such factors as the increased life expectancy, improved quality of life, advances in medical technology as well as pre-operative and post-operative patient management.Numerous studies confirm that patients undergoing major orthopaedics procedures involving lower extremities, for instance total hip and total knee replacement, constitute the highest risk group for the development of post-operative venous thromboembolism (VTE), primarily manifested as deep vein thrombosis (DVT).PurposeThe purpose of the research was to assess the dynamics of D-dimer level fluctuation during the post-operative period in patients after the cemented or cementless total hip replacement (THR) or total knee replacement (TKR), in order to prove or reject the thesis that the cemented and cementless THR or TKR affects the post-operative D-dimer levels.Material and methodsThe study group consisted of 47 patients aged 29–82 years. Of them, 23 had the cementless THR, 12 subjects had the cemented THR and another 12 patients had the TKR. All of the patients performed to measure the concentration of D-dimers in the peri-operative period at predetermined time points. For the peri-operative period was adopted from time 1 day before surgery to 10-day hospitalization. The subarachnoid block (SAB) was performed in all patients.ResultsThe distribution of D-dimer values throughout the entire post-operative period (up to 10th post-operative day) followed the sinusoid pattern with two peaks in all patients. It was not specific in any group.ConclusionsThe D-dimer level almost doubles during the post-operative period in patients after THR or TKR.Higher level of D-dimers in post-operative period in the research group of patients does not relate to higher risk of thromboembolic disease.

The number of total hip and total knee replacement procedures performed worldwide has tended to surge in recent years, due to the combination of such factors as the increased life expectancy, improved quality of life, advances in medical technology as well as pre-operative and post-operative patient management. Numerous studies confirm that patients undergoing major orthopedics procedures involving lower extremities, for instance total hip and total knee replacement, constitute the highest risk group for the development of post-operative venous thromboembolism [VTE], primarily manifested as deep vein thrombosis [DVT].

Introduction D-dimers are products of fibrin being degraded by thrombin, factor XIIIa and plasmin. Their blood concentration is used in clinical diagnostics for venous thromboembolism (VTE) which involves deep vein thrombosis (DVT) and pulmonary embolism (PE). Purpose Surgical operations within the femoral bone are one of the most often performed ones in orthopedic wards. In order to determine an impact of bone injury on the risk of occurrence of a thromboembolic disease we compared the preoperative concentration of D-dimers between a group of patients hospitalized due to femur fracture and a group of patients hospitalized due to coxarthrosis or gonarthrosis. Material and methods The study involved overall 404 patients, divided into two groups. The first group enrolled 283 patients who underwent elective surgery on the femoral bone: total hip replacement (THR) and total knee replacement (TKR) due to osteoarthritis of large joints. The second group enrolled 121 patients who underwent surgery due to femoral fracture. All patients underwent a physical examination for an occurrence of varicose veins in lower limbs. No clinical features of venous thromboembolism were found in patients qualified for the study, based on examination of the venous system in lower limbs, which was supplemented by ultrasound examination. Preoperative blood concentrations of D-dimers were measured in all participants. Results In patients undergoing scheduled joint replacement surgery due to coxarthrosis or gonarthrosis D-dimers concentrations ranged between 122 and 7712 ng/mL, with a mean of 822.3 ng/mL (SD 811.2 ng/mL). It was markedly lower than these found in patients with femur fracture: they ranged from 23.6 to 48340 ng/mL, mean 8793.2 ng/mL (SD ± 10358.6 ng/mL). Conclusions It is suggested that elevated D-dimers levels observed in patients with femur fracture are not associated with an increased risk of occurrence of a thromboembolic disease.