Postoperative surveillance for deep venous thrombosis with duplex ultrasonography after total knee arthroplasty.

Grady-Benson, John; Oishi, Calvin S.; Hanson, Peter B.; Colwell, Clifford W.; Otis, Shirley M.; Walker, Richard

doi:10.2106/00004623-199411000-00008

Cited by 109 publications

(53 citation statements)

References 39 publications

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“…However, duplex ultrasonography is noninvasive and can be used repeatedly to monitor DVT. Moreover, compared with venography, duplex ultrasonography reportedly has an 89% to 100% sensitivity, 100% specificity, and 99% to 100% accuracy for detection of proximal DVT and 83% to 92% sensitivity, 98% to 100% specificity, and 97% to 98% accuracy for detection of distal DVT [2,10,11,15,18,27], and this method thus is considered by some to be the gold standard diagnostic procedure for DVT [2,10,11,15,18,27]. Finally, the patients in our study had different types of treatment such as primary or revision hip arthroplasty, with or without osteotomy, cemented or cementless, simultaneous bilateral or unilateral, and early or delayed full weightbearing.…”

Section: Discussionmentioning

confidence: 99%

Natural Course of Asymptomatic Deep Venous Thrombosis in Hip Surgery without Pharmacologic Thromboprophylaxis in an Asian Population

Tsuda

Kawasaki

Nakamura

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Section: Discussionmentioning

confidence: 99%

Natural Course of Asymptomatic Deep Venous Thrombosis in Hip Surgery without Pharmacologic Thromboprophylaxis in an Asian Population

Tsuda

Kawasaki

Nakamura

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…When compared with venography, Duplex ultrasonography is reported to show 100% sensitivity, specificity and accuracy for the detection of proximal DVT and 88% sensitivity, 98% specificity, and 98% accuracy for distal DVT. 18 White and Helpenstell 19 reported 100% sensitivity, 94% specificity and 95% accuracy of Duplex ultra- The range of flexion of patients who had TKA with a tourniquet. Fig.…”

Section: Discussionmentioning

confidence: 99%

The tourniquet in total knee arthroplasty

Wakankar

Nicholl

Koka

et al. 1999

The Journal of Bone and Joint Surgery. British volume

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We assessed the influence of the use of a tourniquet in total knee arthroplasty in a prospective, randomised study. After satisfying exclusion criteria, we divided 77 patients into two groups, one to undergo surgery with a tourniquet and one without. Both groups were well matched. The mean change in knee flexion in the group that had surgery without a tourniquet was significantly better at one week (p = 0.03) than in the other group, but movement was similar at six weeks and at four months. There was no significant difference in the surgical time, postoperative pain, need for analgesia, the volume collected in the drains, postoperative swelling, and the incidence of wound complications or of deep-venous thrombosis.We conclude that the use of a tourniquet is safe and that current practice can be continued.

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“…Without prophylaxis after TKA, the overall incidence of deep-venous thrombosis (DVT) is between 40% and 84%, with proximal thrombosis being observed in 8% to 24% of patients. 2,3,[7][8][9]11,14,[17][18][19][20]22,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Propagation of calf thrombosis to more proximal thrombi has been demonstrated by Doouss 4 and Kakkar et al, 26 and most recently by Grady-Benson et al 8 who used serial venous Dopper flow measurements to document a propagation rate of 24% in the calf. Therefore prophylaxis after TKA is essential to prevent thromboembolic disease.…”

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confidence: 99%

Meta-analysis of thromboembolic prophylaxis after total knee arthroplasty

Westrich

Haas

Mosca

et al. 2000

The Journal of Bone and Joint Surgery. British volume

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We performed a meta-analysis of the English literature to assess the efficacy of four common regimes for thromboembolic prophylaxis after total knee arthroplasty: aspirin, warfarin, low-molecular-weight heparin (LMWH) and pneumatic compression. We reviewed 136 articles and abstracts published between January 1980 and December 1997. Papers not using routine venography and a lung scan or angiography to detect deep-venous thrombosis (DVT) and pulmonary emboli (PE) respectively, were excluded. Of the 136 studies, 23 with 6001 patients were selected.The incidence of DVT was 53% (1701/3214) in the aspirin group, 45% (541/1203) in the warfarin group, 29% (311/1075) in the LMWH group, and 17% (86/509) in the pneumatic compression device group. Intermittent pneumatic compression devices and LMWH were significantly better than warfarin (p < 0.0001) or aspirin (p < 0.0001) in preventing DVT.The incidence of asymptomatic PE was 11.7% in the aspirin group (222/1901), 8.2% (101/1229) in the warfarin group and 6.3% (24/378) in the pneumatic compression group. No studies with LMWH used routine lung scans. Warfarin and pneumatic compression were significantly better than aspirin in preventing asymptomatic PE (p < 0.05).The incidence of symptomatic PE was 1.3% (23/1800) in the aspirin group, 0.4% (2/559) in the warfarin group, 0.5% (2/416) in the LMWH group and 0% (0/177) in the pneumatic compression group. No statistically significant difference was noted between the above prophylatic regimes due to the very small incidence of symptomatic PE. measurements to document a propagation rate of 24% in the calf. Therefore prophylaxis after TKA is essential to prevent thromboembolic disease. Current prophylactic methods include pharmacological regimes such as aspirin, warfarin, and low molecularweight heparin (LMWH) and mechanical techniques such as intermittent pneumatic compression devices. 1,3,5,6,11,13-18,21-25,27,29,32-38. While pharmacological prophylaxis may be useful for the prevention of thromboembolic disease, associated morbidity such as haemorrhagic complications, routine phlebotomy, excessive cost, and dosing by injection after discharge may limit its use. 1,3,6,11,13,17,18,[22][23][24]29,[32][33][34][35][37][38][39] Pneumatic compression devices offer prophylaxis without such associated morbidity, but compliance by patients and nurses is essential. In addition, the type and duration of prophylaxis after hospital discharge are controversial.To determine the relative benefit of different types of prophylaxis after TKA, we performed a meta-analysis to assess the effectiveness of four commonly used regimes of thromboembolic prophylaxis: aspirin, warfarin, LMWH and intermittent pneumatic compression devices. A metaanalysis is a technique which follows a set of statistical methods that can integrate the results of individual studies. Thus, a quantitative summary of studies with an increase in statistical power and an improvement of the estimated size of an effect can be presented.

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Postoperative surveillance for deep venous thrombosis with duplex ultrasonography after total knee arthroplasty.

Cited by 109 publications

References 39 publications

Natural Course of Asymptomatic Deep Venous Thrombosis in Hip Surgery without Pharmacologic Thromboprophylaxis in an Asian Population

Natural Course of Asymptomatic Deep Venous Thrombosis in Hip Surgery without Pharmacologic Thromboprophylaxis in an Asian Population

The tourniquet in total knee arthroplasty

Meta-analysis of thromboembolic prophylaxis after total knee arthroplasty

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