The prevalence of venous thromboembolism after hip and knee replacement surgery

Abstract

Objective: To determine the prevalence of venous thromboembolism (VTE) after total hip replacement (THR), total knee replacement (TKR) or bilateral TKR in a large sample of patients in a major hospital orthopaedic unit. Design, setting and patients: The Mater Misericordiae Hospital, North Sydney, NSW, a 195‐bed private hospital. All patients who had THR, TKR or bilateral TKR at the hospital between 1 April 1995 and 31 December 2001 had physical prophylaxis (graduated compression elastic stockings or intermittent pneumatic compression, or both) and chemical prophylaxis (anticoagulant) against VTE. All underwent ultrasonography of both legs before discharge, with a small, symptomatic group also undergoing a ventilation/perfusion lung scan (V/Q scan) and computed tomographic pulmonary angiography. Main outcome measures: Prevalence of deep‐vein thrombosis (DVT) and symptomatic pulmonary embolism (PE) before discharge. Results: Among a total of 5999 patients, the pre‐discharge prevalence of DVT after THR, TKR or bilateral TKR was 8.9%, 25.6% and 36.9%, respectively. The prevalence of symptomatic non‐fatal in‐hospital PE was 1.9%, while the prevalence of fatal in‐hospital PE was 0.05%. Conclusions: Despite short‐term chemical and physical thromboprophylaxis, the prevalence of DVT after lower‐limb joint replacement, measured by pre‐discharge ultrasonography, was high. The rate of symptomatic non‐fatal in‐hospital PE was moderate, but fatal in‐hospital PE was rare.

Thromboprophylaxis in patients undergoing total hip and knee arthroplasty: a review of current practices in an Australian teaching hospital

“…Pooled analysis of data from the Regulation of Coagulation in Orthopaedic Surgery to Prevent Deep Vein Thrombosis and Pulmonary Embolism (RECORD) trials revealed a 0.85% incidence of symptomatic VTE following THA and TKA. When patients routinely undergo venography or ultrasonography post‐operatively, incidence figures for VTE are significantly higher than our findings and other reported rates of symptomatic VTE . This likely includes thromboses that may otherwise have not become apparent clinically.…”

“…When patients routinely undergo venography or ultrasonography post-operatively, incidence figures for VTE are significantly higher than our findings and other reported rates of symptomatic VTE. [32][33][34][35][36] This likely includes thromboses that may otherwise have not become apparent clinically. It is likely that several of the thromboses included in our figures were detected through screening ultrasonography prior to discharge.…”

Apixaban versus enoxaparin in the prevention of venous thromboembolism following total knee arthroplasty: a single‐centre, single‐surgeon, retrospective analysis

“…Furthermore, differences in bleeding outcomes were not detected between the two agents. VTE outcomes were much lower in this trial, secondary to the inherent lower VTE frequency following THA . Although similarities exist between the ADVANCE trials and our study, differences in the timing of administration of thromboprophylaxis limits the validity of a direct comparison.…”

Primary care management of postoperative shoulder, hip, and knee arthroplasty

“…This was despite chemical and physical thromboprohylaxis. 13 The rate of equivalent asymptomatic deep vein thrombosis after shoulder arthroplasty was found to be about 13% in one prospective study. 14 The rate of symptomatic deep vein thrombosis is much lower, however.…”