Markers of Thrombin Generation During Resurfacing and Noncemented Total Hip Arthroplasty: A Pilot Study

Abstract

Background Hip resurfacing arthroplasty (HRA) could be associated with an increased risk of deep vein thrombosis (DVT) compared to traditional noncemented THA because it involves greater dissection, increased kinking and distortion of the femoral vessels, takes longer to perform, and involves insertion of some cement into the femur. Questions/purposes Does HRA lead to greater risk of thromboembolism compared with noncemented THA? Methods We prospectively studied 20 patients receiving HRA and 20 receiving THA. All patients were younger than 67 years old and were similar in height, weight, American Society of Anesthesiologists status, and gender mix. Patients undergoing HRA were younger (mean, 50 versus 59 years), their surgery was longer (mean, 87 versus 65 minutes), and they required more crystalloid during surgery (mean, 2160 versus 1662 mL). Radial artery blood samples were taken at six events during surgery and assayed for prothrombin fragment F1 + 2 and thrombinantithrombin III complex (TAT) using enzyme-linked immunosorbent assays. Results We observed no differences in the intraoperative increases in F1 + 2 and TAT between the two groups and no differences in surgical events. Conclusion Based on these data, HRA and THA should have similar risk of thromboembolism as THA based on the parameters we measured. Level of Evidence Level I, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

Changes in Markers of Thrombin Generation and Interleukin-6 During Unicondylar Knee and Total Knee Arthroplasty

“…The major limitation of this data is that an increase in markers of thrombosis does not mean patient will develop a DVT. Furthermore, the degree of activation of these markers has never been linked to venographic evidence of DVT [17]. It merely demonstrates an activation of thrombosis has occurred which in this case was independent of the degree of metabolic injury from surgery.…”

“…Changes in F1+2 and TAT as markers of thrombin generation have been extensively studied as markers of thrombosis during total joint arthroplasty [13–17, 21]. They have been useful in defining the timing of onset of thrombogenesis (e.g., surgery on the femur during total hip arthroplasty) [14, 16] and the relative thromboembolic risks of different procedures e.g., cemented vs. non-cemented hip arthroplasty [14].…”

“…They have been useful in defining the timing of onset of thrombogenesis (e.g., surgery on the femur during total hip arthroplasty) [14, 16] and the relative thromboembolic risks of different procedures e.g., cemented vs. non-cemented hip arthroplasty [14]. Another study showed no difference between uncemented THA via the posterior approach and resurfacing hip arthroplasty [17]. Prior studies have demonstrated an increase in markers of thrombosis during TKA [15, 21] performed with or without tourniquet [13].…”

“…A third option is to study markers of thrombin generation during surgery to determine the degree of activation of thrombosis during surgery compared to TKA. This has been utilized in multiple studies in joint arthroplasty providing information on the timing of thrombogenesis and relative risks between procedures [13–17]. Circulating markers of thrombogenesis are byproducts of the activated coagulation cascade, and therefore should be elevated when clot formation is occurring.…”

Current controversies in hip surgery

“…11 However, there is no significant difference in the serum levels of thrombogenic markers when comparing resurfacing with THR. 12 The issue of thromboprophylaxis and lower limb arthroplasty remains controversial. [13][14][15][16] However, several questions remain unanswered, including whether there is an association between screened deep-vein thrombosis (DVT) and death from pulmonary embolism (PE), if there is an increased risk of bleeding from pharmacological thromboprophylaxis, what the association is between screened DVT and the post-phlebitic limb, and the true impact of orthopaedic surgery on death from PE.…”