Deep Venous Thrombosis After Knee Arthroscopy: A Meta-analysis (original) (raw)
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Prevention of deep-vein thrombosis in ambulatory arthroscopic knee surgery
Arthroscopy-the Journal of Arthroscopic and Related Surgery, 2002
The risk of deep vein thrombosis (DVT) in patients undergoing arthroscopic knee surgery is not well known. The purpose of this study was to determine the incidence of DVT, to demonstrate the efficacy of a perioperative and postoperative prophylaxis against thromboembolism with use of low-molecular weight heparin (LMWH), and to show the safety and feasibility of LMWH administration. Type of Study: Prospective, single-blind, randomized clinical trial. Methods: There were 218 consecutive outpatients scheduled for ambulatory arthroscopic knee surgery eligible. Of these, 130 patients were randomized to a treatment group with LMWH (dalteparin: 2,500 IU Յ70 kg and 5,000 IU Ͼ70 kg, started perioperatively and given once daily for 4 weeks; n ϭ 66) and a control group (n ϭ 64) with no prophylaxis. To detect DVT, all patients underwent bilateral compression ultrasonography before and 12 and 31 days after surgery. Results: Among the 130 patients studied, thromboembolism was significantly lower in the treatment than in the control group: 1 of 66 (1.5%) versus 10 of 64 (15.6%); 95% confidence interval, 7.8% to 26.8%; P ϭ .004. Eighty percent of DVT occurred within the first 14 postoperative days. No severe side effects of LMWH were observed. Only 5% of patients refused continued subcutaneous LMWH injections. Conclusions: In patients undergoing ambulatory arthroscopic knee surgery without antithrombotic prophylaxis, the risk of DVT is high. Perioperative and postoperative prophylaxis with dalteparin is an effective and safe means of reducing this risk.
BMC Musculoskeletal Disorders
Background: We sought to document the incidences of deep vein thrombosis (DVT) before and after total knee arthroplasty (TKA). In addition, we aimed to explor whether routine preoperative DVT evaluation was useful to establish DVT treatment strategies after TKA. Finally, we wanted to evaluate whether the incidences of DVT differed between patients undergoing unilateral and staged bilateral TKA within the same hospitalization period. Methods: The retrospective study included 153 consecutive patients (253 knees) with osteoarthritis who underwent primary TKA. After surgery, mechanical compression devices (only) were used for DVT prophylaxis. DVT status before and after TKA was determined via 128-row, multidetector, computed tomography/indirect venography. Results: Overall, the preoperative DVT incidence was 2.6% per patient and 1.6% per knee. All preoperative DVTs were distal in nature and asymptomatic. After TKA, newly developed thrombi were evident in various calf veins, without propagation of any pre-existing thrombi. Postoperatively, the overall incidences of DVT were 69.9% per patient and 58.5% per knee. The DVT incidences were 66% per patient and 69.8% per knee in the unilateral TKA group. In contrast, the incidences were 72% per patient and 55.5% per knee in the staged bilateral TKA group. There was one case of symptomatic distal (unilateral TKA; 0.65% per patient and 0.4% per knee) and proximal DVT (bilateral TKA; 0.65% per patient and 0.4% per knee), respectively. Conclusions: The incidence of symptomatic DVT was low in Asian patients treated with mechanical compression devices alone, although substantial portion of patients had DVT after surgery. Routine preoperative DVT evaluation is probably not necessary; preoperative DVT was rare and of limited clinical relevance. Furthermore, staged bilateral TKA during a single period of hospitalization does not increase the incidence of DVT.
The Journal of Arthroplasty, 2008
Our objective of the study was to address the question: "What is the efficacy of a deep venous thrombosis (DVT) and pulmonary embolus prophylaxis protocol after total knee arthroplasty (TKA) in which low-risk patients had only aspirin and mechanical devices for prophylaxis?" A multimodal approach to DVT prophylaxis using aspirin as the primary mode of chemoprophylaxis was successful in preventing DVT-related morbidity and mortality in 312 consecutive TKAs performed in low-risk patients. There were no DVT-related deaths and no deaths in general at 90 days of follow-up coupled with a low rate of readmission for thromboembolic events and no readmissions or reoperations from bleeding in this group. This lowmorbidity, low-cost prophylaxis should be considered an appropriate protocol for low-risk patients undergoing TKA. Of all TKAs performed during the time period of the study, 73% qualified for the low-risk group.
Open Journal of Orthopedics, 2019
Introduction: Total knee arthroplasty, being a major surgery, carries a risk of post-operative deep vein thrombosis (DVT). The main objective of the present study was to elucidate the association of clinical, laboratory, and echographic findings with the occurrence of DVT. Patients and Methods: The present study was prospective and non-randomized, with restricted exclusion criteria. Forty patients were submitted to total knee arthroplasty due to osteoarthritis. Patients were clinically evaluated by laboratory tests, assessment of pain and calf circumference, and the presence of Homans' sign. Echo Doppler was performed in each patient on postoperative day 7. The echographic evaluation divided the patients into two groups: positive (G1) and negative for thrombosis (G2). All patients received prophylactic heparin during the 7-day hospital admission. Results: Eleven patients complained of pain (analgesic medication was used during the entire admission). Leg circumference variation from the pre-operative period to post-operative day 7 was: G1, 1.70 ± 1.12 cm and G2, 0.68 ± 1.25 cm (p = 0.03). Homans' sign was considered positive in 10 patients. Echographic evaluation was positive in 11 patients (27.5%). No cases of pulmonary embolism, infection, or death were observed. Conclusions: The incidence of DVT was 27.5%, with an increase in leg circumference being the main predictive factor (p = 0.03).
Symptomatic Deep Vein Thrombosis Following Elective Knee Arthroscopy Over the Age of 40
Clinical and Applied Thrombosis/Hemostasis
Thromboprophylaxis following arthroscopic knee surgery (AKS) is not clear in the literature. The purpose of this study was to present the incidence of symptomatic deep vein thrombosis (DVT) following elective AKS over the age of 40. The secondary purpose was to investigate risk factors associated with venous thromboembolic events (VTEs). Surgical database and outpatient clinic follow-up charts of the patients who underwent AKS for any reason were included in the study. Odds for risk factors such as previous medical history of thrombosis, any family history for clotting disorders, diabetes mellitus (DM), oral contraceptive usage, body mass index, history of malignancy, and smoking were evaluated. The incidence of DVT following AKS significantly increased in the patients older than 40 years who had a previous medical history of VTE, DM, and smoking. A variety of guidelines exist for VTE prophylaxis; however, one should focus on risk factors related to the patient’s medical history and...
The risk of venous thromboembolism in non-large-joint surgeries
Orthopedics, 2003
The risk of venous thromboembolism, particularly deep venous thrombosis, after knee arthroscopy, surgically assisted arthroscopy, or treatment of lower extremity fracture may be substantial in patients with factors known to increase the risk of postoperative thromboembolism. Few prospective studies have examined the effect of prophylaxis in these patient populations. However, results suggest that routine administration of a low-molecular-weight heparin reduces the rate of deep venous thrombosis in such patients. Additional clinical studies are necessary to determine whether the benefits of prophylaxis outweigh its risks and whether it is cost-effective. Until such data are available, risk for deep venous thrombosis must be assessed in all patients undergoing an orthopedic procedure. Thromboprophylaxis with pharmacologic agents may be considered in those at high risk.
Clinical profile of patients on DVT prophylaxis undergoing major lower limb orthopedic surgeries
International Journal of Orthopaedics Sciences
It has been known for a long time that clinical symptoms and signs are of little help in the diagnosis of venous thrombosis of the legs because they lack both sensitivity and specificity. This applies to calf tenderness, pain on dorsiflexion of the foot (the Homan's sign), increased skin temperature, ankle and calf edema, and superficial venous dilatation. Contrast venography, the first objective test and still the gold standard in the diagnosis of venous thrombosis. This clinical prospective study on Efficacy of Enoxaparin as a Thromboprophylactic agent in major lower limb orthopedic surgeries was conducted in department of Orthopedics. During the study period, 180 patients undergoing Surgeries for fracture around hip, femur fracture surgery, patients undergoing Hip and Knee Arthroplasty were given prophylaxis for DVT.A prior consent was obtained from all the patients and the study was approved by the Ethical Committee of the Hospital. The Youngest patient in this study was 20 years and oldest 85 years of age. The average age being 54 years.43.3% of patients were 60 and above, 21.11% between 50-59, 16.11% between 40-49, 9.44% between 30-39 and 10% between 20-29 years of age. Indications for Hemiarthroplasties were fracture neck of femur in forty two cases. Total Hip Replacement was done in six cases, three of them had avascular necrosis of head of femur and three of them had secondary arthritis of hip. Total Knee Replacement for primary osteoarthritis was done in twenty four cases.
Update on the risks of complications after knee arthroscopy
BMC Musculoskeletal Disorders
Background: Knee arthroscopy is one of the most common surgical procedures worldwide and the number of arthroscopies has substantially increased in the last 30 years. Thus, our aim was to provide updated estimates on the risk of complications and compare it with the background risk in the general population. Methods: We identified patients aged 15-84 years with knee arthroscopy in the years 2005-2016 in southern Sweden. We calculated the risk of pyogenic arthritis, venous thromboembolism, and other typical complications within 30 days. As a reference cohort we included the regional population in the corresponding age interval. We estimated the relative and absolute risks of complications compared to the reference cohort using logistic regression adjusted for age, sex, and level of education. We also estimated the proportion of complications in the population explained by knee arthroscopy (population attributable fraction). Results: We identified 18,735 knee arthroscopy patients (mean age 39 years) and 1,171,084 reference subjects (mean age 46 years). The absolute risk of one or more complications was 1.1% after knee arthroscopy and 0.16% in references. The odds ratio of any complication after knee arthroscopy vs. the reference cohort was 9.4 (95% confidence interval [CI] 8.1, 10.9) with an absolute risk difference of 1.4% (1.1, 1.6%). The relative risk (95% CI) for pyogenic arthritis was 115 (75, 174), venous thromboembolism 6.8 (5.1, 9.1), and other complications 7.7 (6.3, 9.5). The population attributable fraction for pyogenic arthritis was 5%. Conclusions: The absolute risks of complications associated with knee arthroscopy remain small at about 1%. Still, 5% of all pyogenic knee arthritis cases in adults are attributable to knee arthroscopy, thus risks with knee arthroscopy should be carefully considered in the choice of treatment.