Postthrombotic Syndrome After Hip or Knee Arthroplasty

Ginsberg, Jeffrey S.; Gent, Michael; Turkstra, Franktien; Büller, Harry R.; MacKinnon, Betsy; Magier, D.; Hirsh, Jack

doi:10.1001/archinte.160.5.669

Cited by 140 publications

(103 citation statements)

References 8 publications

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“…surgery have been reported, including infection, 9,10 pulmonary embolism, 11,12 thromboses, 11,[13][14][15] fat embolism, 16 hemarthrosis, 17 patellar fracture, 18 heterotopic ossification, 19,20 stiffness, 21,22 nerve damage, 11,23 vascular injuries, 11,14,24,25 and urinary complications. 11,12 The perioperative mortality rate has been reported at 0.17%-0.46% for primary total knee arthroplasty within 90 days [26][27][28] and 0.33%-0.78% for bilateral knee replacements within 30 days.…”

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confidence: 99%

Total Knee Replacement Delayed With Hylan G-F 20 Use in Patients With Grade IV Osteoarthritis

Waddell¹,

Bricker²

2007

JMCP

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steoarthritis (OA) and other rheumatic conditions are the leading cause of disability in the United States. 1 The prevalence of OA of the knee in various countries can be estimated as 18% of men and women as inferred by a recent meta-analysis.2 OA can also result in significant direct and indirect costs, which are higher with greater disability. 3 Current therapeutic options for OA are approved to treat the pain associated with the disorder. The American College of Rheumatology recommends the initial use of nonpharmacologic techniques, such as patient education, weight loss, and physical therapy, followed by pharmacologic therapies such as acetaminophen and cyclooxygenase (COX)-2-specific inhibitors. 4 Intra-articular hyaluronan therapy is recommended for patients who are no longer responsive to nonpharmacologic and pharmacologic treatments or who may be experiencing adverse side effects with nonselective nonsteroidal inflammatory drugs or COX-2-specific inhibitors. 4 Total knee replacement (TKR) is considered a last resort for treatment of OA knee pain in appropriate patients when other therapies fail. According to the National Hospital Discharge Survey published by the U.S. Department of Health & Human Services, approximately 326,000 patients in the United States received a TKR in 2001. 5 In a sample of 6,856 decedents aged ≥65 years, 2.1% were found to have received knee replacements. 6 The cost of knee replacement surgery at patient discharge was reported as $24,045 for 2001. 7 The success of TKR in most patients has been supported by more than 20 years of follow-up data. 8 While TKR is an effective option for OA pain relief for many patients, it is not medically desirable for some patients (age, heart disease, diabetes, pulmonary disease, obesity, or generalized medical debilitation) or is not preferred by others. Additionally, complications of the ABSTRACT BACKGROUND: Total knee replacement (TKR), a last resort for treating knee pain due to osteoarthritis (OA), is not always medically indicated or preferred by many patients. Hylan G-F 20 is a cross-linked hyaluronan derivative approved for the treatment of pain due to OA of the knee after other conservative approaches have failed.OBJECTIVE: The objectives of this study were to (1) determine the effect of hylan G-F 20 on patient need for TKR as measured by time from hylan G-F 20 injection to TKR, and (2) assess patient factors that might influence time from hylan G-F 20 therapy to TKR.METHODS: This is a retrospective case series review of the medical records of patients seen in 1 orthopedic specialty practice. The incidence and time to TKR in patients who were TKR candidates (100% grade IV OA [severe]) treated with 1 or more courses of intra-articular hylan G-F 20 injections (3 weekly injections per course) were determined from October 1997 to November 2003. Survival analysis was used to evaluate time to TKR and the effects of age, gender, ethnicity, body mass index (BMI), and presence of effusion on this outcome. Logistic regression was also used to assess...

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Total Knee Replacement Delayed With Hylan G-F 20 Use in Patients With Grade IV Osteoarthritis

Waddell¹,

Bricker²

2007

JMCP

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“…The items most commonly endorsed by both patients and experts were pain and edema, which are items included in the tools developed to measure PTS in adults (16,58,59) and children, and are the only items of the Ginsberg criteria for the diagnosis of PTS in adult patients (59).…”

Section: Discussionmentioning

confidence: 99%

Pediatric post-thrombotic syndrome in children: Toward the development of a new diagnostic and evaluative measurement tool

Avila

Brandão

Williams

et al. 2016

Thrombosis Research

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Objective: Our goal was to conduct the generation and piloting of a discriminative and evaluative tool for pediatric post-thrombotic syndrome.Methods: We followed a formative model for the development of the tool, focusing on the signs/symptoms (items) that define post-thrombotic syndrome. For item generation, pediatric thrombosis experts and diagnosed with extremity post-thrombotic syndrome during childhood nominated items. In the piloting phase, items were cross-sectionally measured in children with limb deep vein thrombosis to examine the performance of the items.Result: Twenty-three experts and 16 subjects listed 34 items, which were then measured in 140 subjects with previous diagnosis of limb deep vein thrombosis (70 upper extremity and 70 lower extremity). The items with strongest correlation with post-thrombotic syndrome severity and largest area under the curve were pain (in older children), paresthesia, and swollen limb for the upper extremity group, and pain (in older children), tired limb, heaviness, tightness and paresthesia for the lower extremity group.Conclusion: Diagnostic properties and correlation with post-thrombotic syndrome severity of the different signs and symptoms varied according to the assessed venous territory.The information gathered in this study will help experts decide which item should be considered for inclusion in the new tool.

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“…Additionally, the use of thromboprophylaxis postoperatively not only reduces the incidence of VTE, but may also reduce the size of a thrombus in those who do develop one; and small thrombi are less likely to cause the venous obstruction and valvular damage associated with PTS. 45 Treatment options for PTS are limited to nocturnal leg elevation, vascular surgery, pain management and weight loss; consequently, VTE prevention is crucial to reducing the PTS burden on individuals and society.…”

Section: Post Thrombotic Syndromementioning

confidence: 99%

“…There is evidence that asymptomatic DVT is associated with the development of PTS in medical patients, however not so in patients who undergo lower limb surgery. 42,45,66,67 This may be due to an inherent difference in the nature of provoked and unprovoked VTE, and the physiological capacity of the afflicted patients.…”

Section: Population Symptomatic Vte Incidence (Per 100000) Referencesmentioning

confidence: 99%

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Thromboprophylaxis Following Hip And Knee Arthroplasty

Mirkazemi¹,

Bereznicki²,

Peterson³

2012

Internal Medicine Journal

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Postthrombotic Syndrome After Hip or Knee Arthroplasty

Abstract: Symptomatic PTS is an uncommon complaint after major hip or knee arthroplasty. Patients who develop postoperative proximal or distal DVT and who receive 6 to 12 weeks of anticoagulant therapy are not predisposed to PTS.

Cited by 140 publications

References 8 publications

Total Knee Replacement Delayed With Hylan G-F 20 Use in Patients With Grade IV Osteoarthritis

Total Knee Replacement Delayed With Hylan G-F 20 Use in Patients With Grade IV Osteoarthritis

Pediatric post-thrombotic syndrome in children: Toward the development of a new diagnostic and evaluative measurement tool

Thromboprophylaxis Following Hip And Knee Arthroplasty

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