Venous thromboembolism rates after hip and knee arthroplasty and hip fractures

Abstract

Background: The ideal thromboprophylaxis regime following lower limb arthroplasty and proximal femur fractures remains controversial. Guidelines disagree on the type of chemical prophylaxis, its dose or duration. This article describes a method of monitoring venous thromboembolism (VTE) rates following Total Hip (THA), Total Knee Arthroplasty (TKA) and surgery for hip fractures (NOF#). Methods: Over 3 years, all patients investigated for VTE were analysed using Picture Archiving Communications System (PACS). All positive scans were then cross-referenced using PACS and local registry data to see if they had undergone THA, TKA or NOF# in the preceding 90 days. Mortality data were obtained from the national administrative database, Hospital Episode Statistics. Results: Five thousand seven hundred eighty-eight patients underwent investigation for VTE and there were 29 diagnoses of PE and 24 of DVT. There was a 0.77% rate of symptomatic DVT after THA, 0.05% after TKA and 0.55% after NOF #. The rate of confirmed symptomatic PE for THA was 0.46, 0.27% for TKA and 0.96% for NOF #. Mortality at one-year post-THA was 0.6, 0.6% for TKA and 25.9% after NOF#. All patients contacted either remained within the catchment area for the minimum 90 postoperative days or died within the catchment area. Conclusions: The 90 day post-operative prevalence of symptomatic VTE of 1.2, 0.3 and 1.5% in THA, TKA and NOF # respectively are similar to other studies using symptomatic and imaging positive VTE as their endpoint. The study uses a method of collecting data which can be utilised in centres where PACS is available.

Internal Fixation versus Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fractures in the Elderly: A Systematic Review and Meta‐Analysis

“…Mula points out that the probability of DVT after hip fracture is 0.55%. Suspected DVT should be detected by Doppler ultrasonography in time 31 . The perioperative period is crucial for the prevention of DVT; the use of warfarin, low molecular weight heparin, and elastic socks can effectively reduce the incidence of venous embolism.…”

Association between metabolic syndrome and venous thromboembolism after total joint arthroplasty: a meta-analysis of cohort studies

“…Electronic databases of PubMed, Embase, and the Cochrane’s Library were systematically searched using the combination of the following terms: [ 1 ] “metabolic syndrome” OR “insulin resistance syndrome” OR “syndrome X” [ 2 ]; “hip” OR “knee”; and [ 3 ] “arthroplasty” OR “replacement” OR “surgery” OR “operation”. We used this extensive search strategy to avoid missing potential studies.…”

“…Studies were included if they met the following criteria: [ 1 ] published as full-length article, [ 2 ] designed as cohort studies, [ 3 ] included patients that received TKA or THA, [ 4 ] MetS was identified as exposure of interest at baseline, [ 5 ] documented the incidence of any VTE events (overall VTE, PE, or DVT) in patients with and without MetS, and [ 6 ] reported the adjusted risk ratios (RRs, at least adjusted for age and sex) and their corresponding 95% confidence intervals (CIs) for the incidence of VTE in patients with and without MetS. Definitions of MetS were consistent with what was applied in the original studies.…”

“…If inconsistencies occurred, discussion with the corresponding author was suggested to resolve the disagreement. The following data were extracted: [ 1 ] name of the first author, publication year, study location, and study design [ 2 ]; characteristics and numbers of patients that received TKA or THA, criteria for the diagnosis of MetS, prevalence of MetS, and follow-up period; and [ 3 ] number of cases with any VTE events during follow-up, VTE prophylactic strategies, methods for the validation of the outcome, and variables adjusted. The quality of each study was evaluated using the Newcastle-Ottawa Scale (NOS) [ 25 ].…”

“…Patients undergoing total joint arthroplasty (TJA), including total knee arthroplasty (TKA) and total hip arthroplasty (THA), are at a higher risk for the development of venous thromboembolism (VTE) [1][2][3]. Despite the routine use of prophylactic measures against thrombosis in these patients, the incidences of VTE, including pulmonary embolism (PE) and deep vein thrombosis (DVT) remains high [4].…”