Background: Patients with cancer who undergo surgery about the hip
are at increased risk for the development of deep vein thrombosis. We
implemented a program of chemical and mechanical prophylaxis to prevent this
problem. This study was performed to assess the effectiveness of that
program.
Methods: Eighty-seven consecutive patients with an active malignant
tumor who underwent hip replacement surgery at our institution over a two-year
period were included in the study. All patients were treated with intermittent
pneumatic compression devices. Seventy-eight patients received anticoagulants,
and nine did not. Postoperative surveillance for proximal deep vein thrombosis
was routinely performed on all patients with duplex Doppler
ultrasonography.
Results: Four patients had proximal deep vein thrombosis, and one
patient, who did not receive anticoagulation, had a nonfatal pulmonary
embolism. The use of prophylactic low-molecular-weight heparin (dalteparin)
was associated with a 4% rate of proximal deep vein thrombosis (three of
seventy-eight patients). Proximal deep vein thrombosis developed in three of
eight patients with pelvic disease, one of nineteen patients with femoral
disease, and zero of sixty patients with hip disease (p <
0.00001). The prevalence of proximal deep vein thrombosis was significantly
higher (p < 0.02) following replacements in patients with sarcoma
(three of twenty-one) than it was after replacements in patients with
carcinoma (zero of fifty-seven) or hematologic malignant disease (one of
nine). On multivariate analysis, only the location of the disease (the pelvis,
femur, or hip) was found to be independently significant for an association
with deep vein thrombosis. A wound complication developed in four of
twenty-one patients with sarcoma and no patient with carcinoma or hematologic
malignant disease (p < 0.001). The pathologic type was the only factor
studied that was independently significant for an association with wound
complications on multivariate analysis.
Conclusions: The rate of proximal deep vein thrombosis in patients
who had undergone hip replacement for oncologic indications was low when the
use of an intermittent pneumatic compression device was supplemented with
prophylaxis with low-molecular-weight heparin.
Level of Evidence: Therapeutic Level II. See Instructions
to Authors for a complete description of levels of evidence.