Deep vein thrombosis after uncemented total hip replacement

Area of Science:

• Orthopedic Surgery
• Vascular Surgery
• Thrombosis Research

Background:

• Deep vein thrombosis (DVT) is a significant risk following primary uncemented total hip replacement.
• Prophylactic regimens are crucial for mitigating DVT incidence.
• Understanding risk factors and intraoperative effects on venous flow is essential.

Purpose of the Study:

• To determine the natural incidence of deep vein thrombosis (DVT) after hip replacement.
• To evaluate the effectiveness of aspirin and low-molecular-weight dextran prophylaxis.
• To identify risk factors and intraoperative venous dynamics associated with DVT.

Main Methods:

• A randomized trial involving 114 patients undergoing venography post-hip replacement.
• Comparison of DVT incidence between control, aspirin, and low-molecular-weight dextran groups.
• Intraoperative venography in 10 patients to assess femoral vein blood flow and kinking.

Main Results:

• DVT incidence: Control (20%), Aspirin (11.5% - insignificant reduction), Dextran (5.2% - statistically significant reduction).
• DVT predominantly occurred in iliofemoral/calf veins (control) vs. popliteal/calf veins (prophylaxis groups).
• Obesity and long-term steroid use were confirmed risk factors; severe limb swelling was a key clinical sign.

Conclusions:

• Low-molecular-weight dextran is effective in reducing DVT after hip replacement.
• Minimizing internal rotation of the hip joint during surgery may prevent venous kinking and thrombosis.
• Routine hematologic analysis is not predictive of DVT development.