Abstract
Introduction
This is a retrospective review of the incidence of deep venous thrombosis (DVT) in 679 consecutive unilateral primary hip arthroplasty procedures performed between January 2007 and December 2010 managed with no anticoagulants. Mean age at operation was 58 years. Mean BMI was 26. The prophylaxis regimen included hypotensive epidural anesthesia, compression stockings, intermittent calf compression, early mobilization and an antiplatelet agent.
Methods
562 hybrid hip resurfacing procedures and 117 uncemented THRs, all performed through a posterior incision were included. Doppler ultrasound screening for DVT was performed in all patients between the fourth and sixth post-operative days. Patients were reviewed clinicoradiologically 6 to 10 weeks after operation and with a postal questionnaire at the end of 12 weeks to detect symptomatic VTE incidence following discharge. 14 patients with pre-existent VTE, coagulation disorders or cardiac problems requiring anticoagulant usage were excluded.
Results
There were no symptomatic DVTs. Ten cases (1.5%) of asymptomatic below-knee DVT and 1 above-knee asymptomatic DVT (0.15%) were detected on USG. One patient had non-fatal pulmonary embolism but no evidence of lower limb DVT on repeated USG examinations. On investigation he was found to have Prothrombin 20210A mutation. The incidence of DVT was 1.6% (9 of 562) in the resurfacing group and 1.7% (2 of 117) in the THA group, an overall incidence of 1.6% (11/679) in the whole group. Fourteen patients (2.1%) needed a blood transfusion including 9 resurfacings (1.6%) and 5 THAs (4.3%).
Discussion and Conclusion
This combination regimen which offers the prospect of low incidence of venous thromboembolism, without subjecting patients to the higher risks of bleeding associated with anticoagulant usage.
