The incidence of proximal deep vein thrombosis after elective hip arthroscopy: a prospective cohort study in low risk patients

Abstract

Prospectively assess the incidence of deep venous thrombosis (DVT) using Doppler Ultrasound, in patients receiving elective hip arthroscopy without pharmacologic/mechanical prophylaxis. One hundred and fifteen consecutive patients (mean 35.4 years, SD = 10.3) underwent elective hip arthroscopy. Patients with previous major risk factors for DVT were excluded. Signs/symptoms of DVT/pulmonary embolism were assessed at 2-week post-operatively. A bilateral whole leg Duplex color (Doppler) Ultrasonography was scheduled between 10- and 22-day post-op. The primary outcome was frequency of DVT. Secondary outcomes assessed surgical risk factors. One hundred and ten patients (mean = 34.3 years, SD = 10.1) did not get a DVT. Five patients (mean = 43.8 years, SD = 12.1) were diagnosed with a DVT, 2- to 22-day post-operatively. All DVT patients received arthroscopy in the supine position (n = 76), versus no patients in the lateral position (n = 39). Average traction time was 38 (SD = 4) and 61 (SD = 4) minutes for patients with and without a DVT, respectively. All other a priori defined risk factors were similar. Four out of five patients presented with symptoms of a DVT, confirmed by ultrasound. One patient was without symptoms/clinical findings. Four patients had a DVT restricted to the calf veins; one patient had involvement of the popliteal vein. No patients had proximal extension into the thigh or pelvis. No pulmonary emboli were suspected or occurred. The incidence of deep venous thromboembolism is 4.3%. The majority of patients had symptomatic and distal venous thromboembolic events. This study provides supportive evidence that routine prophylaxis and/or screening may not be necessary in low risk patients undergoing elective hip arthroscopy.

Venous thromboembolism prophylaxis after hip preservation surgery: a review and presentation of institutional experience

“…Hip arthroscopy has been used to treat various disorders of the hip [ 58–61 ]. The incidence of VTE after hip arthroscopy has been reported to be between 0 and 6.94% [ 14 , 15 , 62–67 ] ( Table II ). In a recent systematic review on VTE after hip arthroscopy, Haldane et al .…”

“…Mohtadi et al . [ 62 ] conducted a prospective cohort about incidence of VTE after hip arthroscopy that had multiple superiorities comparing to former studies. They excluded patients with previous risk factors for VTE, employed ultrasound and MDCT in order to screen for VTE and found asymptomatic patients and also tried to stratify the surgical risk factors for VTE.…”

A systematic review—meta-analysis of venous thromboembolic events following primary hip arthroscopy for FAI: clinical and epidemiologic considerations

“…Fukushima et al [ 12 ] reported 6.94% incidence of DVT in a cohort of 72 patients. Mohtadi et al [ 13 ] also used Doppler ultrasound to screen patients for DVT on days 10–22 after hip arthroscopy and reported an incidence of 4.3% (4 cases). Ultrasound screening for the development VTE after orthopaedic procedures is not currently recommended in asymptomatic individuals.…”

“…Mohtadi et al [ 13 ] detected one case of asymptomatic DVT by ultrasound screening of a group of low-risk patients who underwent hip arthroscopy in a prospective study. Fukushima et al [ 12 ] detected five asymptomatic cases of DVT (confirmed by ultrasound) in a group of 72 patients who underwent hip arthroscopy for FAI syndrome.…”

Anesthesia for hip arthroscopy: a narrative review

“…A study from our own institution found that the incidence of DVT was \ 4% following elective hip arthroscopy, which further confirms the safety of the procedure with regard to venous thromboembolic events. 66 While current guidelines are lacking for DVT prophylaxis following hip arthroscopy, early mobilization is recommended for all patients and routinely used in our institution. In addition, prophylactic administration of unfractionated heparin 5,000 IU subcutaneously should be considered for patients at increased risk for thromboembolic events, such as a personal history of hypercoagulable syndromes and venous thromboembolism.…”