UPPER GASTROINTESTINAL BLEEDING AS A COMPLICATION AFTER HIP AND KNEE ARTHROPLASTY

Abstract

Introduction and Aims: Use of non-steroidals (NSAIDs) and additional factors such as advanced age, anticoagulants and co-morbid diseases, commonly found in patients with arthritis, increases the risk of upper gastrointestinal (UGI) bleeding. Our aim was to assess the incidence of peri-operative UGI bleeding in patients having hip and knee replacements for arthritis.

Method: A single centre, retrospective study was conducted on 100 consecutive hip replacements and 100 consecutive knee replacements performed at Victoria Infirmary, Glasgow, between 1998 and 2000.

Results: The mean age was 74 (41–86). Sixty-three percent of our patients were female. Seventeen percent of the patients had a previous history of UGI problems, of which only 50% were on gastro-protective medication. Fifty-four percent of the patients were on NSAIDs and all patients received anticoagulants (78 aspirin, 122 clexane) peri-operatively. Nine patients (4.5%) had UGI bleeding in the post-operative period. Five patients had endoscopies, which revealed bleeding from gastric ulcers (three), duodenal ulcer (one) and barretts oesophagus (one). Four patients, who had one episode of UGI bleeding, did not have endoscopies. All the nine patients with UGI bleeding were patients who had been on NSAIDs and anticoagulants (six clexane, three aspirin). These nine patients were from the group of patients who were not on any gastro-protective medication. Five of these patients requiring a hospital stay of more than two weeks.

Conclusion: We believe that the incidence of UGI bleeding in patients undergoing hip and knee replacements is underestimated. We propose gastro protective agents in the peri-operative period for patients on NSAIDs.