Managing thromboembolic risk in hip and knee arthroplasty: state of the art

Deep vein thrombosis and pulmonary embolism are major causes of morbidity and mortality after knee and hip arthroplasty in the United States. Although patients frequently receive prophylaxis for thromboembolism postarthroplasty, surgeons vary in their choice of modality and often use suboptimal strategies due to the possibility of provoking postoperative bleeding. This article discusses the rationale for the prevention of venous thromboembolism and offers an overview of clinical recommendations for prophylaxis in knee and hip replacement surgery. Supporting medical evidence for these recommendations is described. A summary of current prophylactic regimens and discussion of duration of therapy are also presented.