Deep vein thrombosis after elective knee surgery. An incidence study in 312 patients

Stringer, M. D.; Steadman, CA; Hedges, A R; Thomas, EM; Tr, Morley; Vv, Kakkar

doi:10.1302/0301-620x.71b3.2785998

Cited by 214 publications

(103 citation statements)

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“…To reiterate, given the lack of symptomatic VTE diagnosed in our series, further statistical analysis of the risk factors mentioned here was not possible. Despite our results not appearing to suggest a correlation with tourniquet use and symptomatic VTE, it is recommended to avoid the use of tourniquet compression in cases of multiligamentous knee reconstruction in which the patient underwent vascular repair with their initial trauma [7,10,38,44,46,47].…”

Section: Discussioncontrasting

confidence: 63%

“…As such, these patients are at risk of developing venous thromboembolism (VTE). Numerous reports have documented the frequency of and risk factors for developing a VTE after hip and knee arthroplasty, knee arthroscopy, lower extremity trauma, and even hip arthroscopy [2,3,5,7,16,17,29,35,41,43,45,47]. However, data with regard to VTE after multiligamentous knee reconstruction are scarce [9].…”

Section: Introductionmentioning

confidence: 99%

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Low Frequency of Symptomatic Venous Thromboembolism After Multiligamentous Knee Reconstruction With Thromboprophylaxis

Born¹,

Engasser

King

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Reconstruction of the multiligament-injured knee often involves extended surgical and tourniquet use times and often is performed in patients who have sustained concomitant fractures as well as vascular injuries, all of which would appear to predispose the patient to the potentially serious complications of deep vein thrombosis and perhaps pulmonary embolism, yet little is known about the frequency of venous thromboembolic (VTE) events after multiligamentous knee reconstruction. Questions/purposes The purposes of this study were to (1) determine the frequency of symptomatic VTE after multiligamentous knee reconstruction at a single institution; and (2) to determine associated risk factors for VTE in these patients. Methods The records of 134 (63% of the 213 consented individuals in our longitudinal database) patients who underwent primary (129 [96%]) or revision (five [4%]) multiligamentous knee reconstruction at a single institution between 1992 and 2013 were retrospectively reviewed. With two patients undergoing procedures bilaterally, this resulted in a total of 136 multiligamentous knee reconstructions. VTE for which clinical symptoms were evident and confirmed by imaging within 3 months after the reconstructive procedure was noted. Pre-and perioperative data were collected with respect to demographics, associated injuries, medical history, smoking status, and surgical data. Standard rehabilitation and thromboprophylaxis protocols were used in all patients. Results Three cases of symptomatic VTE (three deep vein thromboses) occurred after the 136 reconstructions (2%; 95% confidence interval, 0.53%-7.3%). Two of the three patients were obese and the remaining patient smoked and abused alcohol. However, as a result of a low frequency of VTE, no risk factors could be identified in this series. Conclusions Symptomatic VTE occurred in 2% of multiligamentous knee reconstructions at our institution while receiving thromboprophylaxis. This is similar to rates documented after anterior cruciate ligament reconstruction without thromboprophylaxis. Further multicenter research is required to identify the true frequency of and risk factors for developing VTE in patients undergoing multiligamentous knee reconstruction after knee dislocation. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Section: Discussioncontrasting

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Low Frequency of Symptomatic Venous Thromboembolism After Multiligamentous Knee Reconstruction With Thromboprophylaxis

Born¹,

Engasser

King

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…This is much higher than has been reported, although our patients received LMWH prophylaxis; the rate of DVT in 0th: er studies varies from 0% to 7% and the incidence of pulmonary embolism from 0% to 3% (DeLee 1985, Small 1986, Stringer et al 1989, Kakkar et al 1970, Poulsen et al 1993, Williams et al 1995. DVT and PE are probably underestimated, as they are often asymptomatic and therefore not clinically detected.…”

Section: Discussionmentioning

confidence: 60%

Thromboembolic complications after arthroscopic knee surgery: Incidence and risk factors in 101 patients

Schippinger

Wirnsberger

Obernosterer

et al. 1998

Acta Orthopaedica Scandinavica

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“…In such cases pressure is not uniform because it is governed by the individual's systolic blood pressure. Burkart et al [4] used 300 mmHg and Stringer et al [15] 500 mmHg. A pressure of 100 mmHg above systolic blood pressure is recommended by Worland et al [18] to reduce thigh pain following tourniquet application.…”

Section: Discussionmentioning

confidence: 99%

The effect of tourniquet use in total knee arthroplasty

Vandenbussche

Duranthon

Couturier

et al. 2002

International Orthopaedics

157

152

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We conducted a prospective, randomised study on primary total knee replacements to evaluate the effects of tourniquet use on total calculated blood loss using Gross formula, post-operative measured blood loss, operating time, need for blood transfusion, post-operative pain, analgesia requirement and knee flexion. Forty patients were operated on with the use of an arterial tourniquet with pressure of 350 mmHg (group A), and 40 patients without the use of a tourniquet (group B). Total calculated blood loss was significantly increased (P=0.0165) without the use of a tourniquet. There was no significant difference in measured blood loss or operating time. The median units of blood given were similar in both groups. In spite of autologous transfusions 14% of patients received additional homologous transfusions. At 6 h post-operatively pain was significantly less (P=0.0458) in group B but was similar at 24 and 48 h. There was no significant difference in analgesia requirement. The mean change in total flexion in group B was significantly better (P<0.001) at 5 days than in group A, but knee flexion was similar at 10 days and 3 months. Knee arthroplasty operations without the use of a tourniquet cause a greater blood loss but have only small benefits in the early post-operative period.Résumé Une étude prospective et randomisée a été réali-sée sur 80 arthroplasties totales du genou consécutives de première intention dans le but d'évaluer l'effet de l'utilisation du garrot pneumatique sur les pertes sanguines totales calculées selon la formule de Gross, les pertes sanguines mesurées par drainage aspiratif, la durée opératoire, la né-cessité de transfusion sanguine, la douleur post-opératoire, le besoin d'antalgique et la récupération de la flexion du genou. Quarante patients ont été opérés avec un garrot pneumatique gonflé à 350 mmg (group A), et quarante sans garrot pneumatique (group B). Les pertes sanguines totales calculées étaient plus élevées de façon significative (P=0.0165) dans le groupe B. Il n'y avait pas de différence significative entre les deux groupes sur les pertes sanguines mesurées par drainage aspiratif et la durée opératoire. Le nombre de culots globulaires nécessaire était le même dans les deux groupes. Malgré un protocole d'autotransfusion, 14% des patients ont eu une transfusion homologue complémentaire. La douleur post-opératoire était significativement moindre (P=0.0458) à la sixième heure dans le groupe B mais était identique à 24 et 48 heures. Il n'y avait pas de différence sur la consommation d'antalgique. La flexion dans le groupe B était meilleure (P<0.001) au cinquième jour que dans le groupe A, mais était identique à 10 jours et au troisième mois post-opératoire pour les deux groupes. La non-utilisation d'un garrot pneumatique apporte quelques bénéfices dans la période post-opératoire immédiate mais est responsable d'une majoration des pertes sanguines totales calculées. IntroductionDespite progress in pre-operative autologous donation, intraoperative normovolaemic haemodilution and...

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Deep vein thrombosis after elective knee surgery. An incidence study in 312 patients

Cited by 214 publications

References 0 publications

Low Frequency of Symptomatic Venous Thromboembolism After Multiligamentous Knee Reconstruction With Thromboprophylaxis

Low Frequency of Symptomatic Venous Thromboembolism After Multiligamentous Knee Reconstruction With Thromboprophylaxis

Thromboembolic complications after arthroscopic knee surgery: Incidence and risk factors in 101 patients

The effect of tourniquet use in total knee arthroplasty

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