Total hip replacement and deep vein thrombosis. A venographic and necropsy study

Abstract

Bilateral venography was performed between 12 and 15 days after total hip replacement in 745 consecutive patients, all of whom had heparin prophylaxis. Of these, 81 patients (10.8%) showed evidence of recent deep vein thrombosis: 23 (3%) distal, 44 (5.9%) isolated proximal, five (0.7%) both proximal and distal, and nine (1.2%) extensive thrombosis from calf to thigh. Compared with previous reports heparin appeared to have reduced the number of distal and contralateral thromboses, but was far less effective in reducing proximal femoral thrombosis. In a cadaver study, the femoral veins were inspected during simulated total hip replacement by either an anterior or a posterior approach. In every case the femoral vein became kinked or folded in the thigh position imposed during the preparation of the femur. Local damage appears to be an important factor in proximal thrombosis; care at operation could help to minimise trauma to the femoral veins and reduce the number of such cases.

Secondary cement injection technique reduces pulmonary embolism in total hip arthroplasty

“…This has been described before [13,31] and is attributed to the operation procedure during stem insertion [18], which results in a clearly reduced or even ceased blood flow [32]. During joint reposition, when the leg is stretched again, and the temporarily occluded femoral vein is re-opened, the newly formed thrombi are washed out [18].…”

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

“…Improved understanding of the pathogenesis of venous thromboembolism during THA has identified certain intraoperative factors as being vitally important; particularly, the duration and severity of femoral venous occlusion during surgery and the importance of reaming and cement fixation of the stem [19,20,22,23]. These processes have been studied using transesophageal echocardiography [19], perioperative venography [21,22], and by measuring markers of thrombin generation [8,23].…”

“…It involves extensive surgical exposure and prolonged periods of potential femoral venous occlusion [20,22], which could result in a greater risk of thrombogenesis than in a traditional THA. On the other hand, there is minimal reaming of the femoral canal, which may reduce the thrombogenic risk.…”

Thromboembolism After Intramedullary Nailing for Metastatic Bone Lesions

“…Estimated rates of inpatient DVT and PE among patients receiving prophylaxis following hip or knee arthroplasty are approximately 0.5% to 1% 5 . The risk of VTE is also increased in long-bone fractures [6][7][8][9][10][11][12] . Aggressive anticoagulation postoperatively, however, must be balanced with the risk of severe wound or bleeding complications 13,14 .…”