ARTERIAL AND VENOUS THROMBOEMBOLIC COMPLICATIONS AFTER MAJOR ORTHOPAEDIC SURGERY.

Abstract

Major bone surgery causes damage to the bone marrow cells and destruction of blood vessels. This induces a tremendous local and systemic thrombin generation. This may trigger vascular instability during surgery that in seldom cases may be fatal in susceptible patients in particular if bone cement is implanted. The overall mortality following elective hip replacement is low since the patients are selected for the procedure and medically optimized. Following emergency hip fracture surgery the patients are substantially older, many have co-morbid conditions and the mortality is markedly higher. Vascular events dominate. Pulmonary embolism, and myocardial infarction are prominent together with pneumonia (a condition that trigger the coagulation system).

Postoperatively, thrombin continues to be generated for a long time after surgery as a part of the inflammatory healing process. Vascular complications dominate and epidemiological studies have shown a general complication risk period lasting for nearly 3 months and significantly longer in subgroups. Although, mortality has decreased in recent years, morbidity continues to play an important and less focused role although with substantial health economic implications.