Venous Thromboembolism Following Arthroscopic Knee Surgery: A Current Concepts Review of Incidence, Prophylaxis, and Preoperative Risk Assessment

Graham, William C.; Flanigan, David C.

doi:10.1007/s40279-013-0121-2

Cited by 27 publications

(29 citation statements)

References 70 publications

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“…A systematic review of 56 articles by Graham et al (10) showed a wide variance in the reported incidence of DVT in arthroscopic surgery. The authors attributed the variation to the large heterogeneity of the study populations, differences in the inclusion and exclusion criteria, and the different diagnostic methods used.…”

Section: Discussionmentioning

confidence: 99%

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Deep vein thrombosis in arthroscopic surgery and chemoprophylaxis recommendation in an Asian population

Yeo

Lim

Lee

2016

smedj

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INTRODUCTIONThere are currently no guidelines supporting the use of routine chemoprophylaxis to prevent deep vein thrombosis (DVT) in arthroscopic surgery. Studies and meta-analysis show opposing views on its routine use in arthroscopy. This study aimed to examine the incidence of DVT in a prospective cohort of knee arthroscopy and knee arthroplasty patients, and to analyse the risk factors contributing to DVT. METHODSAll patients scheduled to undergo knee arthroscopy or arthroplasty over a two-year period were included.A standardised regimen of postoperative mechanical prophylaxis and rehabilitation was applied to all patients. Only patients who were postoperatively symptomatic were referred for ultrasonography. DVT incidence was calculated, and univariate and multivariate analyses of the risk factors were performed. RESULTSThe overall incidence of DVT was 0.5% among the 1,410 arthroscopy patients and 3.1% among the 802 arthroplasty patients. The incidence of proximal DVT among the arthroscopy and arthroplasty patients was 0.4% and 1.1%, respectively. Multivariate analysis showed that age was the only signifi cant predictor of DVT incidence. Using the receiver operating characteristic method, the cut-off age for the arthroscopy and arthroplasty patients was 52 years, while that for the arthroscopy patients only was 40 years (increased risk of DVT: 5.46 and 6.44 times, respectively; negative predictive value: 99.7% and 99.8%, respectively).CONCLUSION DVT incidence among Asian arthroplasty and arthroscopy patients remains low, even without chemoprophylaxis. Since age was found to be a signifi cant risk factor for DVT, DVT prophylaxis can be considered for patients in high-risk age groups.

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Section: Discussionmentioning

confidence: 99%

“…(10) Thus, there is a need to further stratify patients who are undergoing knee arthroscopic surgery so that better decisions can be made on whether chemical thromboprophylaxis should be used.…”

Section: Discussionmentioning

confidence: 99%

Deep vein thrombosis in arthroscopic surgery and chemoprophylaxis recommendation in an Asian population

Yeo

Lim

Lee

2016

smedj

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“…There is no consensus on the appropriate thromboprophylaxis for patients undergoing knee arthroscopy. 20 Krych et al 9 stated that thromboprophylaxis should be considered in patients undergoing arthroscopy who meet one of the following criteria: (1) history of malignancy, long-term use of anticoagulants, use of estrogen-progestin oral contraceptives or hormone replacement therapy, or history of vascular disease; or (2) two or more of the classic DVT risk factors described in the literature. 9,10 Bohensky et al 21 identified additional risk factors for venous thromboembolism, including older age (>60 years), presence of comorbidity, marriage, major mechanical issues, and undergoing the procedure in a public hospital.…”

Section: Discussionmentioning

confidence: 99%

Venous Thromboembolism After Knee Arthroscopy in Undiagnosed Familial Thrombophilia

Jetty¹,

Glueck²,

Freiberg³

et al. 2016

Orthopedics

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Venous thromboembolism is uncommon after knee arthroscopy, and there are no guidelines for thromboprophylaxis in elective routine knee arthroscopy. Preoperative evaluation of common thrombophilias should provide guidance for postarthroscopy thromboprophylaxis in otherwise healthy patients who are at high risk for venous thromboembolism. This study assessed 10 patients with venous thromboembolism after total hip or knee arthroplasty. Patients were assessed if venous thromboembolism occurred within 6 months after knee arthroscopy (n=10) or total hip or knee arthroplasty (n=21). This study assessed gene mutations (factor V Leiden, prothrombin G20210A, plasminogen activator inhibitor, methylenetetrahydrofolate reductase) and serologic thrombophilias (high levels of factors VIII and XI, homocysteine, anticardiolipin immunoglobulin G and immunoglobulin M antibodies, and lupus anticoagulant; low antigenic protein C, S, and free S; and antithrombin III deficiency). The same coagulation data were obtained for normal subjects (n=110). The major thrombophilias in the arthroscopy group were factor V Leiden heterozygosity (40%), high factor VIII level (50%), and high homocysteine (30%). The respective values in control subjects were 2% (P=.0004), 7% (P=.0011), and 5% (P=.02). When the arthroscopy group was compared with the 21 patients who had venous thromboembolism after total hip or knee arthroplasty, the sole difference was factor V Leiden heterozygosity, which was 40% vs 0%, respectively (P=.007). Although venous thromboembolism after knee arthroscopy is uncommon, to identify high-risk patients and guide postoperative thromboprophylaxis, the authors suggest routine preoperative measurement of 3 common familial thrombophilias: factor V Leiden, factor VIII, and homocysteine. [Orthopedics. 2016; 39(6):e1052-e1057.].

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“…54,55 A subset of cases occurring after arthroscopy are asymptomatic and detected at screening US. 55,56 In a more recently published study performed on a large cohort of patients, the incidence of symptomatic DVT after knee arthroscopy was 0.34%. 57 Although cases of calf DVT may be localized to the peroneal or posterior tibial veins, a substantial number of cases occur in the intramuscular veins of the gastrocnemius and/or soleus (►Fig.…”

Section: Calf Deep Vein Thrombosismentioning

confidence: 98%

Musculotendinous Disorders in the Lower Leg

Newman

2017

Semin Musculoskelet Radiol

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Musculotendinous injury in the lower leg is associated with a variety of athletic activities. Myotendinous strain is typically localized to the posterior calf muscles, with involvement of the medial head of gastrocnemius muscle most common. Nontraumatic soft tissue injuries of the lower leg, including muscle herniation, are less frequently imaged. Ruptured popliteal cysts and deep vein thrombosis are important differential considerations in the patient presenting with acute calf pain and swelling.

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Venous Thromboembolism Following Arthroscopic Knee Surgery: A Current Concepts Review of Incidence, Prophylaxis, and Preoperative Risk Assessment

Cited by 27 publications

References 70 publications

Deep vein thrombosis in arthroscopic surgery and chemoprophylaxis recommendation in an Asian population

Deep vein thrombosis in arthroscopic surgery and chemoprophylaxis recommendation in an Asian population

Venous Thromboembolism After Knee Arthroscopy in Undiagnosed Familial Thrombophilia

Musculotendinous Disorders in the Lower Leg

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