Incidence of deep vein thrombosis following shoulder replacement surgery: a prospective study

Koch, O; Plessis, Anne-Marie du; Olorunju, Steve; McLoughlin, H.A.; Roux, Tlb le

doi:10.17159/2309-8309/2017/v16n4a5

Cited by 1 publication

(5 citation statements)

References 36 publications

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“…These include advanced age in those receiving arthroplasty as a treatment for osteoarthritis or trauma, or patients with inflammatory arthropathies. 22,32 During the intra-operative period, kinking of the axillary vein may occur during humeral positioning, leading to vessel wall injury. 22 This, however, does not occur in elbow or wrist arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

“…8 In the post-operative period, the arm may routinely be immobilised in a sling, which may contribute to venous stasis. 32 Also, patients may lose some mobility after surgery, and prolonged sitting may lead to kinking of the femoral veins and gravitational pooling of blood in the lower limb, increasing venous stasis and lower limb DVT. 22,32 This may also provide an explanation for the more frequently reported lower limb DVT seen after upper limb joint replacement surgery, compared to upper limb DVT episodes that were only described in two included articles in this systematic review.…”

Section: Discussionmentioning

confidence: 99%

“…32 Also, patients may lose some mobility after surgery, and prolonged sitting may lead to kinking of the femoral veins and gravitational pooling of blood in the lower limb, increasing venous stasis and lower limb DVT. 22,32 This may also provide an explanation for the more frequently reported lower limb DVT seen after upper limb joint replacement surgery, compared to upper limb DVT episodes that were only described in two included articles in this systematic review. 21,29 Interestingly, this suggests that the pathogenesis of VTE following upper limb joint replacement may be influenced more significantly by systemic factors, rather than local factors such as limb manoeuvring, chemical cement use or post-operative limb positioning.…”

Section: Discussionmentioning

confidence: 99%

“…22,30 Aspirin has recently been shown to be effective, inexpensive and safe form of VTE prophylaxis following lower limb arthroplasty and has been introduced into national guidance. 11,41,42 Otherwise, two authors utilised a LMWH-based VTE prophylaxis protocol in selected 'high-risk' patients, 25,32 reporting a VTE incidence of 0.3% and 12.3%, respectively. Interestingly, after the implementation of the 2007 NICE guidance advising the prescription of LMWH to all orthopaedic inpatients, there was no significant difference in total VTE events before and after universal use of LMWH.…”

Section: Discussionmentioning

confidence: 99%

“…These included one study that excluded patients with VTE prophylaxis, 21 to mechanical (graduated compression and intermittent pneumatic compression devices) and pharmacological (aspirin and low molecular weight heparin (LMWH)) methods. 20,22,25,30,32 Of note, the effects of VTE prophylaxis on overall (VTE) risk reduction or complication rates were not reported and no direct comparisons were made between patients undergoing joint replacement with or without VTE prophylaxis.…”

Section: Shoulder Arthroplastymentioning

confidence: 99%

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Is venous thromboembolism prophylaxis beneficial in upper limb major joint replacement surgery? A systematic review

2020

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Background Upper limb arthroplasty is an increasingly used treatment modality for end-stage joint disease of the shoulder, elbow and wrist. Whilst complications have been reported, the risk of venous thromboembolism has received less attention when compared to the lower limb. Guidance to aid clinical decision-making remains limited. This review aims to ascertain whether venous thromboembolism prophylaxis is beneficial after upper limb major joint replacement surgery. Methods A systematic review was performed in April 2019, utilising EMBASE, MEDLINE, Cochrane and Google Scholar. All clinical studies reporting venous thromboembolism incidence and risk reduction (after prophylaxis) in upper limb joint replacement were included. Results Twenty-four observational studies were identified. The reported incidence of venous thromboembolism ranged from 0.2% to 16% (weighted mean 0.68%) and 0.2% to 0.8% (weighted mean 0.49%) in shoulder and elbow arthroplasty, respectively. No records for wrist arthroplasty were found. In the literature, baseline venous thromboembolism risk of patients without an operation is reported as 0.5%. Discussion There is a lack of good quality evidence regarding the risks and benefits of venous thromboembolism prophylaxis in upper limb major joint replacement surgery. We recommend further research, ideally formal randomised controlled trials to guide recommendations. Although venous thromboembolism is rare in upper limb surgery, surgeons should remain vigilant to this possibility.

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Section: Discussionmentioning

confidence: 99%