8 hours ago Because of the high risk of venous thromboembolism (VTE) in total hip replacement (THR) and total knee replacement (TKR), guidelines are used widely to enhance effective (yet safe) prophylaxis. If patients develop VTEs despite use of such guidelines, then the reasons are that the guidelines were: (i) followed but the VTE occurred anyway; (ii ... >> Go To The Portal
Important risk factors that have been shown to be associated with the development of VTE after hip surgery include (1) a history of prior VTE, (2) obesity (body mass index > 25), (3) delay in ambulation after surgery, and (4) female sex.
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Elective total hip and total knee arthroplasty surgeries are associated with an extraordinarily high incidence of asymptomatic venous thromboembolism (VTE). Symptomatic deep vein thrombosis (DVT) or pulmonary embolism (PE) is diagnosed in only 2%-4% of these patients. A number of studies have define …
Today, unfortunately, DVT and PE remain an issue for total knee and total hip arthroplasty patients: The readmission rate for DVT and PE after joint replacement surgery is between 5% and 14%, adding to patient morbidity and the cost of the episode of care. [2]
RESULTS Of 2,214 patients undergoing THR (n=1,330) or TKR (n=884), 25 (1.13%) experienced VTE. Four THR patients experienced VTE (2 of which were avoidable) and 21 TKR patients experienced VTE (5 of which were avoidable).
Abstract INTRODUCTION Because of the high risk of venous thromboembolism (VTE) in total hip replacement (THR) and total knee replacement (TKR), guidelines are used widely to enhance effective (yet safe) prophylaxis.
Deep venous thrombosis (DVT) is a common complication after hip arthroplasty, with an incidence rate of 40–60 %[7]. The formation of DVT of the lower extremities can increase the suffering of patients, prolong hospitalization time, and increase medical expenses[8].
Citing several published studies, Heit says the risk period for clots in the deep veins, for instance, can be up to 12 weeks after hip replacement and up to six weeks after knee surgery. These long-term risks are the most important for patients to know about, he says.
The most common minor complications were joint stiffness (18.5%), swelling (15.6%) and paraesthesia (15.6%), while the most common major complications were arthroplasty-related readmission (6.0%) and reoperation (2.5%; Table 3).
A home health assessment of the post-operative status of a patient with hip replacement surgery focuses on the following five elements:surgical wound healing, including assessing for signs of site infection.pain control.bed-chair transferring ability.transferring ability to and from toilet or commode.More items...•
Let your doctor know right away if you have any signs of DVT or PE: Pain or tenderness in your leg. Swelling or warmth in your leg. Red or discolored skin on your leg.
Prevention and Treatment of Blood Clots after Hip and Knee Replacement SurgeryExercise/physical therapy beginning the first day after surgery and continuing for several months.Compression stockings.Anti-clotting medicine to reduce the body's ability to form blood clots.
Hip replacement complications include blood clots, change in leg length, dislocation, fractures, infection and loosening of the implant. People who have received metal-on-metal hips may also experience metallosis, a form of metal poisoning that causes tissue damage and other serious conditions.
Risks associated with hip replacement surgery can include:Blood clots. Clots can form in the leg veins after surgery. ... Infection. Infections can occur at the site of the incision and in the deeper tissue near the new hip. ... Fracture. ... Dislocation. ... Change in leg length. ... Loosening. ... Nerve damage.
Procedures such as endoscopy and angiography may be used to find the source of your bleeding, or to control it. An endoscope is a long, bendable tube with a light on the end of it. An angiogram is a picture of your arteries. You may be given a dye to help the blood vessels show up better.
Assessing the patency of a patient's airway, vital signs, and level of consciousness are initial priority. The nurse will closely monitor the patient's cardiac, respiratory, and neurovascular status (NVS) along with the surgical dressing and drain for overt signs of excessive bleeding.
Always sit with your hips higher than your knees.Point your toes straight ahead; don't turn the toes of your affected leg inward.Do not bend your hip more than 90 degrees. ... Do not turn your toes (or knee) inward.Do not cross your legs. ... Do not try to stand up or walk with a dislocated hip.
Expect moderate to severe swelling in the first few weeks after surgery. You may also have mild to moderate swelling for 3 to 6 months after surgery. To reduce swelling, elevate your leg slightly and apply ice. Wearing compression stockings may also help reduce swelling.
Hip arthroplasty, however, is associated with a higher incidence of asymptomatic proximal thrombi and a modestly higher incidence of symptomatic VTE events, many diagnosed up to 6 or 8 weeks after hospital discharge.
Important risk factors that have been shown to be associated with the development of VTE after hip surgery include (1) a history of prior VTE, (2) obesity (body mass index > 25), (3) delay in ambulation after surgery, and (4) female sex. Factors associated with lower risk include ...
Pulmonary embolism is a life-threatening condition, with a high mortality rate. Recent studies show that 30-day mortality is 4%, but may increase to 13% after 90 days (1). The risk of developing a PE increases during and after surgery and it depends from the type of surgery and patient risk factors. Orthopedic procedures have the highest incidence ...
A 56- year old men arrived in the emergency department because of a brief episode of loss of consciousness. The patient was in good health. He reported that, two weeks before, had undergone a hip left arthroplasty and was in therapy with enoxaparin 6000 units once a day.
Surgical patients are at increased risk of developing a PE, especially after orthopaedic hip and knee surgery, because of positioning during surgery and immobility, that contributes to an increase in venous stasis. Therefore the prophylactic therapy is essential.
The diagnosis of lower extremity DVT was based on the standards in the relevant diagnosis and treatment guidelines [ 13, 14 ]. Postoperative observation of the affected limbs for the following manifestations including limb swelling, pain, elevated skin temperature, skin color changes, venous return disorder, Homans sign, Neuhof’s sign. Color Doppler ultrasound indicated that there was no color blood flow signal and spectrum signal in the venous cavity, no collapse of the venous pressurized lumen, extremely low echo in the venous lumen, and irregular pulse Doppler spectrum. The ultrasound was generally used in the surgical leg, and if there were abnormal symptoms in another leg, we would also detect it for DVT. The inspection area for ultrasound scanning was from inguinal ligament to the distal leg. Patients underwent ultrasound examination every two days after surgery. And if necessary, the venography was performed.
DVT is a disorder of venous return caused by abnormal blood coagulation in the deep veins of the lower extremities, which completely or incompletely obstruct the blood vessels [ 16 ]. It is a common complication after THA and an important cause of unexpected deaths during the perioperative period of such patients [ 17 ]. Therefore, DVT has attracted extensive attention from clinical medical workers. Studies [ 18, 19, 20] have shown that the incidence of DVT in patients treated with THA is 14.13-20.18 %. The results of this study indicate that the incidence of lower limb DVT in patients after THA is 19.78 %, which is lower than the previous report [ 21, 22 ]. It may be related to the differences in the conditions of included patients, surgical method and perioperative preventive anticoagulation treatment amongst different studies.
Deep venous thrombosis (DVT) is a common complication after hip arthroplasty, with an incidence rate of 40–60 % [ 7 ]. The formation of DVT of the lower extremities can increase the suffering of patients, prolong hospitalization time, and increase medical expenses [ 8 ]. Once it falls off, it can easily cause pulmonary embolism, and severe cases can lead to death. The relevant guidelines [ 9, 10] point out that patients who have undergone major operations such as hip replacement without obvious bleeding tendency need to use anticoagulant drugs within 24 h after surgery, but there are still some patients who have DVT under the condition of standardized anticoagulant application. At present, there are many reports [ 11, 12] on DVT of the lower extremities after THA at home and abroad, but there are few studies on systemic analysis of DVT after artificial hip replacement, and the risk factors reported in related studies are relatively limited. It is necessary to further explore the related risk factors. Therefore, in this present study, we aimed to evaluate the influencing factors of DVT of lower limb after THA, to provide evidence support for the prevention and treatment of clinical THA.
Deep vein thrombosis (DVT) of lower limb is one of the common complications after total hip arthroplasty (THA), we aimed to evaluate the potential risk factors of DVT of lower limb in patients with THA, to provide insights into the management of THA.
Endometrial injury, venous blood flow stasis and blood hypercoagulability are the three factors that induce DVT [ 23 ]. The subjects of this study are elderly patients 50 years and older. The elasticity of blood vessels are poor and elder patients are complicated by the physiological or organic changes of multiple organs, and the perioperative period of lower extremity joint mobility and the amount of activity are significantly reduced, so the risk of DVT is higher [ 24, 25, 26 ]. We have found that age > 70y, BMI ≥ 28, diabetes, bilateral joint replacements, duration of surgery ≥ 120 min, cemented prosthesis, and duration of days in bed > 3 days were the independent risk factors of DVT of lower limb in patients with THA. It is clinically necessary to carry out early prevention and intervention for these risk factors of DVT to reduce the occurrence of DVT.
Total hip arthroplasty (THA) is a common surgical treatment in the department of orthopedics and one of the effective treatments for end-stage hip joint diseases, mainly for the elderly [ 1 ]. THA is mainly used to treat joint pain and dysfunction caused by hip joint disease, including hip joint osteoarthritis, femoral head necrosis, bone neck fractures and so on [ 2 ]. At present, more than 500,000 people worldwide receive artificial joint replacement due to fractures, osteoarthritis, bone tumors and other diseases each year [ 3 ]. In China, 30,000 to 50,000 people undergo THA every year [ 4, 5 ]. Through artificial hip replacement, it can relieve joint pain, improve joint function, and correct deformity. And with proper postoperative functional exercise, the patient’s hip joint function may meet the needs of daily life and improve the quality of life [ 6 ].
Several limitations must be concerned in this present study. Firstly, it is worth noting that the sample size of cases selected in this study is small and our study is a single-center study. The results of the study should be treated with caution . Secondly, patient risk stratification is a valid initial approach to ensure better management of patients undergoing THA and to predict who can benefit from a pharmacological preventive strategy, we did not perform individual thromboembolic risk before surgery in this present study. Thirdly, hyperglycemia has been found to be associated with many postoperative complications, in our clinical practice, we would correct the hyperglycemia before surgery. However, we did not detect the glycated hemoglobin routinely, since our study is a retrospective design, we could not collect the most data on the glycated hemoglobin, therefore we could not include those indicators for analysis. Besides, other factors including infections, medications, cancer, trauma and smoking et al. play a significant role in the total amount of post-surgical complications, limited by data, we did not investigate those factors in this present study, more studies on the association of those factors and postoperative DVT are needed. Future studies with larger samples and multi-centers need to further explore the risk factors of DVT in patients undergoing THA, to provide reliable evidence to the prophylaxis of DVT.
A blood clot can complicate the recovery after a major orthopedic surgery such as a knee replacement or a hip fracture surgery.
Keep moving. Move as much as possible after your surgery and exercise as instructed by your healthcare provider to improve blood flow.
A blood clot may affect anyone, but some people are at higher risk. If you are in one or more of these special risk groups, it’s important to learn how to lower your risks.
In general, the AAOS guidelines advocate: Chemical and/or mechanical prophylaxis for normal-risk patients. Chemical and mechanical prophylaxis for high-risk patients. Mechanical prophylaxis for patients with bleeding disorders.
Low-molecular-weight heparin for 5 days preoperatively and 2 days postoperatively if bridging; skip low-molecular-weight heparin if not bridging
Taunton said that the PEPPER study (Comparative Effectiveness of Pulmonary Embolism Prevention After Hip and Knee Replacement) will likely provide answers on chemical prophylaxis. [4] This multicenter study, which includes his institution, Mayo Clinic in Rochester, Minnesota, involves 25,000 patients who are randomized to receive 1 of 3 interventions:
Balanced against the need for prophylaxis to prevent a catastrophic complication is the understanding that a too-aggressive protocol for DVT prophylaxis will put the joint replacement patient at risk for bleeding, hematoma, and wound issues – which could lead to a perioprosthetic joint infection.
Orthopaedic surgeons have known since the earliest days of arthroplasty that patients undergoing elective joint replacement surgery are at risk for deep vein thrombosis (DVT). Dr. John Charnley, the father of total hip arthroplasty, reported a 2.3% rate of fatal pulmonary embolism (PE) in his patients who had not received DVT prophylaxis, ...
It will be several years before orthopaedic surgeons have any answers, though: This ongoing study is scheduled for completion in 2021.
Pieces of a clot can break off and travel through the bloodstream to the lungs. This is called a pulmonary embolism and can be fatal soon after it occurs. Deep vein thrombosis can also block blood flow in the veins, causing the blood to pool.
Deep Vein Thrombosis. One of the risks of hip replacement or knee replacement surgery is deep vein thrombosis (DVT), a serious condition in which a blood clot develops in a vein deep within the body. Such clots are at risk of breaking away and traveling to the lungs, resulting in a pulmonary embolism, which can be fatal.
Preventing deep vein thrombosis is important to prevent pulmonary embolism, which can lead to serious complications, including death.
Treatment may include medications such as: Blood thinners (anticoagulants), which help keep the clot from growing and prevents others from forming. Fibrinolytics, which are known as "clot busters" for their ability to destroy a clot within one or two days. Thrombin inhibitors, which can prevent new clots from forming.
There are a variety of factors that contribute to the development of deep vein thrombosis. including: Hip or leg surgery. Long periods of sitting, such as while traveling or on bed rest. Birth control pills. Certain diseases and conditions, such as varicose veins or arterial diseases. A previous blood clot. Pregnancy.
Getting up and moving as soon as possible, as movement can help to prevent clots from forming by stimulating blood circulation. A pneumatic compression device, which looks like a special fitted sleeve, placed on the legs to help keep blood moving during some types of surgery.
DVT doesn't always have symptoms. In fact, it can occur without symptoms about 50 percent of the time. When there are symptoms, they can include:
The 90 day post-operative prevalence of symptomatic VTE of 1.2, 0.3 and 1.5% in THA, TKA and NOF # respectively are similar to other studies using symptomatic and imaging positive VTE as their endpoint. The study uses a method of collecting data which can be utilised in centres where PACS is available.
The ideal chemo-thromboprophylaxis agent to use and its duration for Total Hip Arthroplasty (THA), Total Knee Arthroplasty (TKA) and surgery for neck of femur fractures (NOF#) remains controversial. The National Institute of Clinical Excellence (NICE) guidelines for THA and NOF#, in England and Wales, recommends mechanical prophylaxis combined with LMWH or Fondaparinox for 4 weeks post-surgery [ 1 ]. The American College of Chest Physicians (ACCP) Grade-1A guidelines recommend either LMWH or Fondaparinox or warfarin (target international normalised ratio of 2.5, range 2.0–3.0) for a minimum of 10 days. The guidelines for TKA are identical but also include the use of pneumatic compression devices [ 2 ]. The doses of pharmaceutical prophylaxis are not specified. Orthopaedic surgeons remain reluctant to implement the guidelines fully [ 3, 4, 5 ]. In our department we utilise 20 mg of Enoxaparin, half of the recommended 40 mg daily dose [ 6 ], for the duration of the in-patient stay [ 7 ]. Comparison of our regime with the recommended 40 mg Enoxaparin dose has suggested no differences in hospital 30-day readmission rates, venous thromboembolism (VTE) rates and postoperative haemorrhage rates in the management of neck of femur fractures [ 7 ]. Our aim was to use the Patient Archiving Communication System (PACS) to find patients with symptomatic VTE occurring within 90 days of the index procedure of Total Hip Arthroplasty (THA), Total Knee Arthroplasty (TKA) and surgery for Neck of Femur fractures (NOF#). This would allow the determination of the rate of symptomatic PE and DVT following hip and knee replacements and hip fractures using this regime. Our methodology of data collection could be adopted at other centres to ultimately enable us to gather larger volumes of data and therefore compare different thromboprophylaxis regimes.
After NOF#, pooled data at approximately 6 months suggests fatal PE rates of 1.9% for those not receiving prophylaxis compared to 1.0% for those receiving prophylaxis [ 15 ]. The ‘ESCORTE study’ reported a confirmed symptomatic VTE rate of 1.34% with a symptomatic PE rate of 0.25% at 6 months following NOF# [ 28 ]. The 90 day post-operative prevalence of symptomatic VTE in this study of 1.2, 0.4 and 1.5% in THA, TKA and NOF # respectively are similar to other studies using clinically symptomatic and imaging positive VTE as their endpoint [ 15, 16, 28, 29, 30, 31, 32, 33 ]. The 90 day PE rates of 0.46% after THA in this study are comparable to the reported 90 day rates 0.68 and 0.6% using LMWH reported in the annual UK National Joint Registry (NJR) Report of 2010 [ 34] and 2007 [ 35] respectively. The 90 day PE rate of 0.27% after TKA in this study compares to the reported rate of 0.6% using LMWH in the annual UK NJR Report of 2007 [ 35 ], and overall 90 day hospitalization rates for VTE of 1.2% following TKA in a Danish population-based study [ 36 ]. The 1 year mortality rates of 0.6% after either THA or TKA in this study are comparable to that reported in the UK NJR of 0.6% [ 34] and 0.7% [ 35] after THA and 0.4% [ 34] and 0.5% [ 35] after TKR. A meta-analysis of 70 studies revealed pooled mortality rate of 0.38% using different thromboprophylaxis regimes [ 37 ]. The lowest rates of 0.2% were in patients receiving multimodal prophylaxis including regional anaesthesia, potent anticoagulants or aspirin, and in patients receiving warfarin combined with regional anaesthesia [ 37 ]. Another study showed the preferential use of aspirin was safe and effective for primary elective hip and knee replacement surgery, with lower rates of bleeding compared to warfarin. The VTE and mortality rates in this study are therefore comparable to reported studies [ 15, 16, 28, 29, 30, 31, 32, 33, 34, 35, 37] despite using half the recommended dose of enoxaparin [ 6, 7] for the duration of hospital stay. The use of this lower dose has been shown to be associated with reduced mortality compared to institutions using a protocol using the recommended 40 mg dose [ 7 ].
There were 15 cases (15 out of 1954, 0.77%) of symptomatic DVT in the THA group. There was 1 case (1 out of 1870, 0.05%) of DVT in the TKA patients and 8 cases (8 out of 1451, 0.55%) of DVT in the NOF # patients (Table 1 ).
The mean time to presentation for symptomatic PE was 22.5 days (SD +/− 21), 9 days (SD +/− 21.7) and 22 days (SD +/− 19.8) and for THA, TKA and NOF# respectively. Mean time to presentation for symptomatic DVT was 19.5 days (SD +/− 21) and 25.5 days (SD +/− 27.6) for THA and NOF #. The single case of symptomatic DVT after TKA presented at 74 days post-operation.
The PACS became online in 2006 with all diagnostic imaging at CGH being stored on the system. A similar system was used at ROPH. PACS was used to identify all recorded positive lower limb Döppler ultrasound scans, Computed Tomographic Pulmonary Angiograms (CTPA) and Ventilation/Perfusion scans (V/Q) within the 3 year study period. The positive results were then checked using PACS at both hospitals to assess if the symptomatic and proven VTE patients had undergone imaging for THA, TKA or surgery for NOF# in the preceding 90 days. This was additionally cross referenced with hospital and operating theatre records, and local arthroplasty registry data (Fig. 1 ). The demographic data and length of hospital stay were available from the clinical coding information.
A flow chart explaining the sequence for calculating the rate of postoperative 90 day VTE. The blue boxes show the 3 stages in the collection of data to calculate the VTE rates. The 2 white boxes show how the method was validated