Lower limb arthroplasty complicated by deep venous thrombosis

Abstract

The aim of this study was to determine the prevalence of deep venous thrombosis (DVT) following lower limb arthroplasty and to assess whether this adversely affected satisfaction, relief from pain, or the level of mobility as perceived by patients. Six hundred and ten consecutive recipients of primary total hip replacement (THR) or total knee replacement (TKR) underwent routine post-operative venography. The functional outcome had already been assessed at one year by using the Regional Arthroplasty Database questionnaire, the results of which were correlated to venographic records. The combined prevalence of DVT after THR and TKR in the patients, who did not receive chemical thromboprophylaxis, was 46.4%. Thrombus was identified in 57.6% of those with a TKR and in 33.5% of patients with a THR. Proximal thrombus was found in 11.0% of TKRs and in 14.8% of THRs. One year after surgery, patients who had a DVT established by venography did not report higher levels of immobility (p = 0.07), discomfort (p = 0.12) or dissatisfaction (p = 0.23) when compared to those with patent venous systems. This suggests that the prevalence of DVT following TKR/THR without chemical thromboprophylaxis is high and these findings are consistent with the literature. However, patients did not perceive thrombosis to compromise their overall outcome. This challenges the belief that DVT is associated with morbidity and calls for further comprehensive research in this area. The low morbidity of the lower limb associated with DVT in these patients does not support the use of chemical thromboprophylaxis.

The incidence of venous thromboembolism following total knee arthroplasty

“…The reported prevalence of postoperative distal DVTs is significantly higher than that of proximal DVTs in patients undergoing TKA [10]. DVTs in lower extremities commonly start in the veins of the calf, and then extend proximally to the thigh [11].…”

Impact of venous thromboembolism on clinical management and therapy after hip and knee arthroplasty

“…9 A higher incidence of distal DVT has been found after TKA compared with THA. 3,18,19 Moreover, symptomatic VTE occurs about 11 days sooner after TKA than THA, with about one-half and two-thirds of the events being diagnosed after hospital discharge in patients who had TKA and THA, respectively. Thus, the differences in the pathogenesis and characteristics of VTE after THA and TKA should be re flected in their clinical management, such that a shorter duration (ACCP recommendation of 10 d) of thromboprophylaxis may be sufficient for patients undergoing TKA, whereas extended prophylaxis after THA is particularly important owing to the prolonged risk for VTE.…”

“…18 Another study reported that the incidence of distal and proximal DVTs was 47% and 11%, respectively, in patients undergoing TKA compared with 19% and 15%, respectively, in patients undergoing THA. 19 Although DVTs often begin intraoperatively, as shown in venographic and leg-scanning studies, some appear to start much later, frequently after hospital discharge. 9 Among patients with postdischarge VTE, some may have asymptomatic DVT early after surgery (e.g., within 1 day after TKA), which then extends to involve the proximal veins.…”

Potential role of electrostimulation in augmentation of venous blood flow after total knee replacement: A pilot study

“…1 The prevalence of positive venographic findings of VTE was reported to be as high as 57.6% in patients undergoing TKR who did not receive chemical prophylaxis. 2 Moreover, symptomatic VTE is quite more infrequent in this population with the incidence being ranged from 0.44% to 2.6% depending on the specific characteristics of the population. 3,4 These highlight the importance of using a standardized prophylaxis regimen against VTE that will outweigh the costs of treatment since most patients with thrombosed lower extremity veins remain asymptomatic without any chemical prophylaxis within 1 year after surgery.…”