The deep vein thrombosis of lower limb after total hip arthroplasty: what should we care

Yu, Xinyan; Wu, Yingying; Ning, Rende

doi:10.1186/s12891-021-04417-z

Cited by 21 publications

(30 citation statements)

References 37 publications

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“…Current literature lacks consensus regarding the most appropriate VTE prophylactic agent for patients undergoing simultaneous bilateral joint replacements. Previous studies comparing different agents examined heterogenous cohorts containing both unilateral and bilateral THA 232-234 . In addition, another study compared the efficacy of aspirin with that of other anticoagulants only after risk-stratifying unilateral cases into a “low-risk” group that received aspirin, and bilateral cases into a “high-risk” group that received potent anticoagulants, thus making it difficult to make a valid comparison 235 .…”

Section: - What Is the Chemoprophylactic Agent Of Choice For Patients...mentioning

confidence: 99%

Recommendations from the ICM-VTE: Hip & Knee

2022

Journal of Bone and Joint Surgery

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The ICM-VTE Hip & Knee Delegates* 1 -Is VTE after elective total joint arthroplasty a "never event"?Response/Recommendation: Venous thromboembolism (VTE) after elective total joint arthroplasty (TJA) continues to occur despite various strategies in prophylaxis and should not be considered a "never event."Strength of Recommendation: Moderate.Delegates vote: Agree 94.87% Disagree 5.13% Abstain 0.00% (Strong Consensus).Rationale: As part of an initiative to address quality of care and control healthcare costs, in 2002, the United States Centers for Medicare and Medicaid Services (CMS) defined "never events" as hospital-acquired conditions that were considered reasonably preventable 1 . In 2008, CMS added deep venous thrombosis (DVT) and pulmonary embolism (PE) following total knee arthroplasty (TKA) and total hip arthroplasty (THA) 2 .Historically, DVT and PE were important risks for patients undergoing TJA. In a study of 7,959 patients between 1962 and 1973, Charnley et al., reported a non-fatal PE rate of 7.89% and a 1.04% rate of fatal PE which constituted the highest single cause of death after a THA 3 . Coventry et al., identified a cohort of 2012 THA from 1969 to 1971 of which 58 did not receive chemoprophylaxis past post-operative day five and observed a DVT rate of 3.4%, a non-fatal PE rate of 5.2%, and a fatal PE rate of 3.4% 4,5 . In a series performed between 1990 and 1991, Warwick et al., identified 1,162 patients undergoing THA without routine chemoprophylaxis, with DVT confirmed by venography in 1.89% of patients and a PE rate of 1.20% with a subsequent mortality rate of 0.34% 6 .Early studies demonstrated a much higher incidence of VTE for TKA 7,8 . However, DVT in TKA patients occur distally in the calf which are less likely to progress into a PE which was observed at a rate of 1.3% 9 with fatalities of 0.19 to 0.4% 9,10 . Stulburg et al., examined a series of 638 patients from 1974 to 1979 among which 49 patients inadvertently did not receive prophylaxis; an impressive 83% of these patients developed a DVT 11 .In a prospective study with 34,397 consecutive and unselected THA or TKA procedures, 32 (0.09%) had a VTE after median two days despite ongoing thromboprophylaxis 12 . All surgery was done in a fast-track setup with accelerated mobilization and discharge. Another study has shown a 90-day incidence of 0.41% of VTE after unicompartmental knee arthroplasty 13 . All patients received thromboprophylaxis until discharge and were operated in a fast-track setup with a median length of stay of one day.With VTE as a common and potentially dangerous complication after TKA and THA, safe and effective strategies for prophylaxis were developed and studied. When warfarin dosage is titrated to an international normalized ratio (INR) of 1.5 to 2.0 and administered for approximately six weeks, DVT occurred at a rate of 0.2 to 1% with a non-fatal PE rate of 0.1 to 0.3% [14][15][16] . Warfarin was found to consistently decreased rates of VTE when utilized after THA or TKA, but may lead to a significant risk ...

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Section: - What Is the Chemoprophylactic Agent Of Choice For Patients...mentioning

confidence: 99%

Recommendations from the ICM-VTE: Hip & Knee

2022

Journal of Bone and Joint Surgery

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“…Femur fractures are a common type of fracture in the elderly and the etiology mainly includes external force hitting, high fall injury, and traffic accidents [8,9] . Hip arthroplasty is an effective means of clinical treatment of femur fracture and its efficacy is relatively precise, but there is a risk of postoperative lower extremity deep vein thrombosis and other complications, and it is necessary to cooperate with corresponding postoperative care measures, so as to promote its postoperative rehabilitation [10,11] . Previous clinical treatment for elderly patients undergoing hip arthroplasty with femoral fracture takes the way of routine nursing mostly, the nursing measures used were relatively single, the nursing content was not abundant enough, and they failed to differ according to the rehabilitation characteristics of patients at different stages of postoperative care, nursing care was not very specific, and the nursing effect was not ideal.…”

Section: Resultsmentioning

confidence: 99%

Study on Therapeutic Application of Huangqi Combined with Staged Care in Elderly Patients

Zhang¹,

Jiaojiao²,

Dong³

et al. 2022

IJPS

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To investigate the clinical effects of huangqi Bazhen decoction combined with traditional Chinese medicine staged rehabilitation care on elderly patients undergoing hip arthroplasty. A total of 200 elderly patients who underwent hip arthroplasty in our hospital from January 2020 to December 2021 were selected and divided into routine group (100 patients) and rehabilitation group (100 patients) according to random number table method. Routine nursing was given to patients in the routine group and huangqi decoction combined with traditional Chinese medicine staged rehabilitation care was given to patients in the rehabilitation group, to compare the effects of the application in the two groups. Compared with preoperative values, Harris scores were significantly higher at 4 w and 8 w postoperatively in both groups, and the scores of the rehabilitation group were higher and significantly different from those of the routine group (p<0.05); the rehabilitation group had a higher rate of excellent hip joint than the routine group, and the difference was significant (p<0.05); all the scores on the short form-36 scale in the two groups after intervention were higher than those before intervention and those of the rehabilitation group were higher than those of the routine group, with significant differences (p<0.05); the rehabilitation group had a lower incidence of postoperative complications than the routine group (p<0.05). The combination of huangqi Bazhen decoction and traditional Chinese medicine staged rehabilitation care can promote postoperative hip recovery in elderly patients undergoing hip arthroplasty, reduce the incidence of complications such as postoperative lower extremity deep vein thrombosis and improve the quality of life of patients.

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“…These findings may suggest a shift in surgical candidate selection during the COVID-19 pandemic to mitigate the risks posed by prior DVT. [ 29 ] Previous studies have demonstrated that patients with a history of DVT who undergo lower limb joint arthroplasty have a higher incidence of DVT during the 90 day post-op period than those with no history of DVT [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%