Has the incidence of deep vein thrombosis in patients undergoing total hip/knee arthroplasty changed over time? A systematic review of randomized controlled trials

Xing, Katharine He; Morrison, Gareth; Lim, Wendy; Douketis, James D.; Odueyungbo, Adefowope; Crowther, Mark

doi:10.1016/j.thromres.2008.05.005

Cited by 71 publications

(65 citation statements)

References 60 publications

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“…A randomized, controlled trial from Japan that enrolled 832 patients demonstrated that the incidence of conventional venography in proven VTE was 36 (41.9 %) out of 86 patients who underwent THA and 48 (60.8 %) out of 79 patients that underwent TKA without antithrombotic prophylaxis, or 20.0 and 29.8 %, respectively, with anticoagulation via subcutaneous enoxaparin (20 mg) twice a day [11]. Although these incidences are similar to those reported in systematic reviews [2,3], the incidence of VTE with anticoagulation was substantially higher in the reviews than in the current study. The higher incidence in the previous study may be explained by the use of conventional venography for screening, which detects mostly small thrombi in the calf veins with high sensitivity [1].…”

Section: Discussionsupporting

confidence: 54%

“…Several studies suggest that a routine antithrombotic strategy reduces the incidence of clinically significant VTE [1][2][3]. However, the true incidence of VTE and the predictive risk factors are not well-defined in patients, with guidelines recommending antithrombotic prophylaxes because most VTE are silent (i.e., asymptomatic) and the diagnostic sensitivity varies substantially among applied imaging modalities.…”

Section: Introductionmentioning

confidence: 99%

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The incidence of pulmonary embolism and deep vein thrombosis and their predictive risk factors after lower extremity arthroplasty: a retrospective analysis based on diagnosis using multidetector CT

et al. 2014

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Section: Discussionsupporting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

The incidence of pulmonary embolism and deep vein thrombosis and their predictive risk factors after lower extremity arthroplasty: a retrospective analysis based on diagnosis using multidetector CT

et al. 2014

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“…On average, patients report significant and sustained improvement in function and quality of life following THA and TKA (9). However, there is a small risk of serious complications, including requirement for early revision surgery, infection, dislocation, venous thromboembolism, and death (all Ͻ2%) (10)(11)(12).…”

mentioning

confidence: 99%

Increased Risk of Complications Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis

Ravi

Croxford

Hollands

et al. 2014

Arthritis & Rheumatology

169

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Objective. Most of the evidence regarding complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are based on patients with osteoarthritis (OA); less is known about outcomes in rheumatoid arthritis (RA). Using a validated algorithm for identifying patients with RA, we undertook this study to compare the rates of complications among THA and TKA recipients between those with RA and those without RA.Methods. In patients who underwent a first primary elective THA or TKA between 2002 and 2009, those with RA were identified using a validated algorithm: a hospitalization with a diagnosis code for RA or 3 physician billing claims with a diagnosis code for RA, with at least 1 claim by a specialist (rheumatologist, orthopedic surgeon, or internist) in a 2-year period. Recipients with diagnostic codes suggesting an inflammatory arthritis, but not meeting RA criteria, were classified as having inflammatory arthritis. All remaining patients were deemed to have OA. Cox proportional hazards models, censored on death, were used to determine the relationship between the type of arthritis and the occurrence of specific complications, adjusting for potential confounders (age, sex, comorbidity, and provider volume).Results. We identified 43,997 eligible THA recipients (3% with RA) and 71,793 eligible TKA recipients (4% with RA). Total joint arthroplasty recipients with RA had higher age and sex-standardized rates of dislocation following THA (2.45%, compared with 1.21% for recipients with OA) and higher age and sex-standardized rates of infection following TKA (1.26%, compared with 0.84% for recipients with OA). Controlling for potential confounders, recipients with RA remained at increased risk of dislocation within 2 years of THA (adjusted hazard ratio [HR] 1.91, P ‫؍‬ 0.001) and remained at increased risk of infection within 2 years of TKA (adjusted HR 1.47, P ‫؍‬ 0.03) relative to recipients with OA.Conclusion. Patients with RA are at higher risk of dislocation following THA and are at higher risk of infection following TKA relative to those with OA. Further research is warranted to elucidate explanations for these findings, including the roles of medication profile, implant choice, postoperative antibiotic protocol, and method of rehabilitation following joint replacement.

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“…There could be several reasons why the incidence of DVT postoperatively is decreasing, the explanation probably being complex and not fully understood. So the proportion of DVT after total knee replacement decreased significantly between 1993 and 2005, warfarin being used throughout [ 11 ]. An important factor, common to all surgeries, is early mobilization, the importance of which clearly shown after knee arthroplasty [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Thromboprophylaxis

Bergqvist¹

2015

The SAGES / ERAS® Society Manual of Enhanced Recovery Programs for Gastrointestinal Surgery

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Postoperative venous thromboembolism (VTE) is a well-known and sometimes lethal complication, and prophylactic measures to decrease the risk have been documented in a vast number of publications. Today this is reflected in several guidelines [ 1 ], and although there are some different views among surgeons, the majority of high-risk patients receive some form of prophylaxis today. When new surgical methods are introduced or old ones are modified, it would seem important to define the risk for various complications, VTE being one, and whether or not thromboprophylaxis should be used. A potential problem is to extrapolate routines without having data supporting the evidence. It is only a little more than a decade the principles of ERPs (enhanced or early recovery after surgery, also called fast-track programs or early recovery programs) were pioneered by Henrik Kehlet in Denmark. Since then these principles have been adopted in many types of surgery and nowadays, the patients are mobilized and sent home rapidly also after rather major surgical treatments. Intuitively this would decrease the risk for VTE. The aim of this chapter is to analyze the risk of VTE after ERAS and the evidence on when and how to use thromboprophylaxis. In Table 9.1 factors are listed, which may reduce the risk of VTE in ERP patients.

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Has the incidence of deep vein thrombosis in patients undergoing total hip/knee arthroplasty changed over time? A systematic review of randomized controlled trials

Cited by 71 publications

References 60 publications

The incidence of pulmonary embolism and deep vein thrombosis and their predictive risk factors after lower extremity arthroplasty: a retrospective analysis based on diagnosis using multidetector CT

The incidence of pulmonary embolism and deep vein thrombosis and their predictive risk factors after lower extremity arthroplasty: a retrospective analysis based on diagnosis using multidetector CT

Increased Risk of Complications Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis

Thromboprophylaxis

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