Major orthopaedic surgery on the leg and thromboembolism.

Parker-Williams, John; Vickers, Roger

doi:10.1136/bmj.303.6802.531

Cited by 41 publications

(10 citation statements)

References 17 publications

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“…Despite pressure from lawyers and other branches of the medical profession, 17,22 many orthopaedic surgeons are reluctant to use chemical prophylaxis because of doubts about its efficacy and possible haemorrhagic complications. 23 Charnley abandoned the use of phenindione because the benefit from a reduction in the mortality rate due to pulmonary embolism was matched by an increased mortality from gastrointestinal haemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Incidence and natural history of deep-vein thrombosis after total hip arthroplasty

Kim¹,

Oh²,

Kim³

2003

The Journal of Bone and Joint Surgery. British volume

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here are many reports concerning the aetiology and prophylaxis of deep-vein thrombosis (DVT) but little is known about its natural history. The purpose of our study was to identify the incidence and site of DVT, the risk factors for pulmonary embolism and the natural history of DVT after total hip replacement (THR) in patients who do not receive any form of prophylactic or therapeutic treatment for DVT.Two hundred patients who had a primary THR were included: 100 had one-staged bilateral THR and 100 had unilateral THR and 150 implants were cemented and 150 cementless. Coagulation assays, a full blood count, blood typing and serum chemical profile tests were performed for all patients on three separate occasions. Bilateral simultaneous or unilateral venograms were performed on the sixth or seventh postoperative day and perfusion lung scans preoperatively and on the seventh or eighth postoperative day. Further venograms were performed in all patients who had thrombi six months later.In the patients with bilateral THR, 52 (26%) venograms were positive for thrombi, while in the patients with unilateral THR 20 (20%) were positive (p = 0.89). In the patients with a cemented THR, 31 venograms (20.7%) were positive for thrombi, while in those with a cementless THR 41 (27.3%) were positive (p = 0.654). Further venograms in all 72 patients who had thrombi at six months after operation showed that they resolved completely and spontaneously regardless of their site and size. No patients had symptoms of pulmonary emboli and none were seen on the perfusion lung scans. Two patients died from unrelated causes. TAlthough the prevailing opinion is that patients with proximal venous thrombosis should be treated with anticoagulants, our study has shown that all thrombi regardless of their site and size resolve spontaneously without associated pulmonary embolism.

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Section: Discussionmentioning

confidence: 99%

Incidence and natural history of deep-vein thrombosis after total hip arthroplasty

Kim¹,

Oh²,

Kim³

2003

The Journal of Bone and Joint Surgery. British volume

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“…2 The use of chemical prophylaxis is associated with a definite incidence of morbidity and mortality due to bleeding complications 3,5,17 and many regimes have been shown to be both expensive and ineffective having poor compliance, especially when using combined modalities. 18,19 Murray et al 1 concluded that "there is no good evidence that any pharmacological agent does more good than harm after a routine total hip replacement" and earlier claims that prophylaxis should be mandatory, 20 have since been put into perspective. In the light of these findings, the views of orthopaedic surgeons appear to be changing, [3][4][5] with a reluctance to accept unnecessary and avoidable complications and a resurgence of interest in mechanical methods of prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

The relationship of foot and ankle movements to venous return in the lower limb

Sochart

Hardinge

1999

The Journal of Bone and Joint Surgery. British volume

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W e have studied the relationship between movements of the foot and ankle and venous blood flow from the lower limb using colourflow Duplex ultrasound to determine the optimum type of exercise for promoting venous return. Studies of both active and passive movements were carried out on 40 limbs in 20 subjects (18 men; 2 women), with a median age of 27 years (20 to 54). We assessed ankle dorsiflexion and plantar flexion, subtalar inversion and eversion, and a combination of all movements. There was no difference in venous flow when comparing opposite limbs in a single subject (p > 0.5), but active exercises produced higher peak and mean velocities of blood flow than passive ones. The active combined movement produced the highest velocities with an increase of 38% in mean and of 58% in peak flow velocities, which were significantly greater than the peak and mean flow rates produced by passive movements. The active combined exercise would therefore be the most effective in eliminating stasis and could contribute to the prevention of deep-vein thrombosis.

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“…On the basis of current knowledge, withholding proper prophylactic measures in patients undergoing major orthopedic surgery is not acceptable (44). It is recommended that LMWH or warfarin be used in patients with hip fractures.…”

Section: Open Questionsmentioning

confidence: 98%

State-of-the-Art Review : Prevention of Venous Thromboembolism in Major Orthopedic Surgery

Prandoni

Goldhaber

Piccioli

et al. 1996

Clin Appl Thromb Hemost

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Venous thromboembolism continues to be a major source of morbidity and mortality in both elective and traumatic orthopedic surgery. Prevention of this complication has received much attention in the orthopedic literature in recent years. We reviewed the relative efficacy and safety of various agents in the prophylaxis of venous thromboembolism arising after major orthopedic surgery. In patients undergoing total hip replacement, low-molecular-weight heparin in fixed doses, adjusted doses of warfarin, and unfractionated heparin in adjusted doses are the most effective prophylactic agents and are highly recommended for routine use. Low-molecularweight heparin or warfarin should be used in patients with hip fractures. Low-molecular-weight heparin, warfarin, or intermittent pneumatic compression should be used in patients undergoing major knee surgery. A number of questions still remain unanswered. In particular, further studies are needed to establish the optimal duration of prophylaxis.

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Major orthopaedic surgery on the leg and thromboembolism.

Cited by 41 publications

References 17 publications

Incidence and natural history of deep-vein thrombosis after total hip arthroplasty

Incidence and natural history of deep-vein thrombosis after total hip arthroplasty

The relationship of foot and ankle movements to venous return in the lower limb

State-of-the-Art Review : Prevention of Venous Thromboembolism in Major Orthopedic Surgery

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