PREVENTION OF VENOUS THROMBOEMBOLISM FOLLOWING TOTAL HIP REPLACEMENTS. THE VIEW FROM THE OPERATING ROOM.

Abstract

Thromboembolism following total hip arthroplasty is a common complication that may result in significant morbidity and mortality. Despite this, optimal prophylactic regimen is controversial. According to the literature, the prevalence of deep venous thrombosis during the early post-operative period ranges from 13% in patients utilizing low molecular weight heparin to 18% in patients treated with sequential compression devices alone.

We investigated the efficacy of a comprehensive approach encompassing the use of aspirin, intermittent compression devices (‘foot pumps’), and early mobilization in a cohort of 290 consecutive patients after non-cemented total hip replacements. The surgical procedures were carried out under epidural anesthesia in most cases (91%). All patients were allowed full weight bearing and received ambulation training starting on the first post-operative day. Ankle-high pneumatic boots (‘foot pumps’) were used early immediately surgery. Aspirin (325 mg po/qd) was used as a pharmacological measure to prevent thromboembolism. The presence of deep vein thrombosis was determined with the routine use of venous duplex scans on post-operative day number 5 to 10 (mean 6.8). The duration of the follow-up was 3 months. No patients were lost to follow-up.

Four distal DVT and two proximal DVT were detected in five patients (3%). None of the patients developed symptomatic pulmonary embolism during the follow-up period. There were no major wound complications.

Venous thromboembolic disease after hip replacement surgery is largely associated with postoperative immobilization and venous stasis. It is the authors’ opinion that a prevention strategy should include mechanical as well as pharmacological measures. The concomitant use of epidural anesthesia, “foot pumps”, aspirin and early full weight bearing ambulation may be effective in further reducing the incidence of DVT after surgery.