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Does total hip arthroplasty predispose to chronic venous insufficiency?

D Warwick1, J Perez, C Vickery

  • 1Avon Orthopaedic Centre, Bristol, United Kingdom.

The Journal of Arthroplasty
|August 1, 1996
PubMed

Insights

Deep vein thrombosis (DVT) is common after total hip arthroplasty, but long-term studies show it rarely causes chronic venous insufficiency. Most patients with prior DVT experienced no significant venous issues years later.

Area of Science:

  • Orthopedic Surgery
  • Vascular Medicine
  • Medical Imaging

Background:

  • Total hip arthroplasty (THA) is a common procedure associated with a risk of deep vein thrombosis (DVT).
  • The long-term sequelae of post-operative DVT following THA, specifically chronic venous insufficiency (CVI), are not well-established.

Purpose of the Study:

  • To investigate the long-term incidence of symptomatic chronic venous insufficiency (CVI) in patients who underwent total hip arthroplasty (THA).
  • To determine the relationship between diagnosed deep vein thrombosis (DVT) after THA and the development of CVI years later.

Main Methods:

  • A retrospective review of 134 limbs (40% retrieval rate) 14-21 years post-THA.
  • Deep vein thrombosis (DVT) was screened using the fibrinogen uptake test and confirmed venographically.
  • Chronic venous insufficiency (CVI) was assessed using clinical grading and photoplethysmography.

Main Results:

  • Clinical CVI was present in 12% of limbs without prior DVT and 11% with prior DVT (P = .77).
  • CVI incidence varied by thrombus location: 9% for calf, 0% for isolated femoral, and 25% for combined calf and femoral.
  • Photoplethysmography identified only 2% of cases as attributable to post-THA DVT.

Conclusions:

  • Despite a high incidence of DVT detected post-THA, symptomatic chronic venous insufficiency is an uncommon long-term outcome.
  • The development of CVI after THA appears to be infrequent, even in patients with confirmed DVT.

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