JBJS | Prophylaxis Against Venous Thromboembolic Disease in Patients Having a Total Hip or Knee Arthroplasty

The Journal of Bone & Joint Surgery, Volume 84, Issue 3

Instructional Course Lecture | March 01, 2002

Prophylaxis Against Venous Thromboembolic Disease in Patients Having a Total Hip or Knee Arthroplasty

Thomas P. Sculco, MD; Clifford W. ColwellJr., MD; Vincent D. PellegriniJr., MD; Geoffrey H. Westrich, MD; Friedrich Böttner, MD

The Journal of Bone & Joint Surgery. 2002; 84:466-477

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Patients undergoing total joint replacement are particularly prone to thromboembolic complications with potentially life-threatening consequences^1-3. Charnley et al., in a series of 7959 total hip replacements performed between 1962 and 1973, reported that the prevalence of nonfatal pulmonary embolism was 7.89% and that the prevalence of fatal pulmonary embolism was 1.04%^4,5. Similarly, in 1974, Coventry et al.⁶ identified an overall prevalence of pulmonary embolism of 2.2% in a series of 2012 consecutive total hip replacements; in a subset of patients who had received no prophylactic anticoagulation, the prevalence of fatal pulmonary embolism was 3.4%. However, the average duration of the operation was 2.4 hours, the average total blood loss was 1650 mL, and the average amount of blood transfused was 1144 mL. Prophylactic anticoagulation with warfarin was started five days after the operation. On the average, patients were managed with bed rest for one week prior to walking and were discharged three weeks after the operation⁶. The prevalence of deep venous thrombosis after total knee arthroplasty is greater than that after total hip arthroplasty. Deep-vein thrombosis is far more refractory to available means of prophylaxis but since the prevalence is greater in the distal part of the limb, symptomatic and fatal pulmonary emboli are far less common. Moreover, it is essential to recognize that thromboembolic disease is manifested clinically as two very different conditions after hip and knee arthroplasty^7,8.

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deep vein thrombosis ; warfarin ; hemorrhage ; hip region ; hip joint ; hip replacement arthroplasty ; knee replacement arthroplasty ; venous thromboembolism ; low-molecular-weight heparin ; pneumatic compression therapy

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These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.

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