Screening for deep-venous thrombosis after hip and knee replacement without prophylaxis

Area of Science:

• Orthopedic Surgery
• Vascular Medicine
• Thrombosis Research

Background:

• Deep-vein thrombosis (DVT) is a significant risk following major orthopedic procedures.
• Prophylaxis strategies are standard in total joint arthroplasty to mitigate DVT risk.
• The specific incidence of DVT without any prophylactic measures requires further investigation.

Purpose of the Study:

• To determine the prevalence of deep-vein thrombosis (DVT) in patients undergoing total joint arthroplasty without any prophylactic treatment.
• To compare DVT rates between total hip replacement (THR) and total knee replacement (TKR) patients.
• To assess the short-term clinical outcomes related to thromboembolic events in this untreated cohort.

Main Methods:

• A consecutive series of 252 patients undergoing total joint arthroplasty were included.
• No chemical or mechanical prophylaxis was administered to any patient.
• Postoperative routine venography was performed to diagnose deep-vein thrombosis (DVT).

Main Results:

• Overall DVT prevalence was 32% after total hip replacement (16% distal, 16% proximal).
• DVT prevalence was significantly higher at 66% after total knee replacement (50% distal, 16% proximal; p < 0.001).
• Distal DVT was not treated; low rates of readmission (2) and death (2) due to thromboembolic disease were observed within three months.

Conclusions:

• Total joint arthroplasty, particularly total knee replacement, carries a high risk of deep-vein thrombosis in the absence of prophylaxis.
• The clinical sequelae of untreated DVT, including pulmonary embolism, appear infrequent in the early postoperative period in this specific patient group.
• These findings underscore the importance of prophylactic measures in reducing DVT incidence after major joint replacement surgery.