NICE guidelines state patients undergoing elective TKR receive post-operative chemical prophylaxis unless contraindicated, following guideline implementation our aim was to determine VTE incidence and wound complication outcomes related to administration of Rivaroxaban or Enoxaparin. From April to October 2010 we prospectively studied 294 patients having primary or revision TKR. Each received either Rivaroxoban (n=219), Enoxaparin (n=68), UHF 5000 units (n=4) or no thromboprohylaxis (n=3) post-operatively. Primary outcome was identification of symptomatic post-operative VTE incidence and compared incidence over the same period in 2009 when aspirin was the standard chemical prophylaxis for VTE. Secondary outcomes were prolonged wound oozing rates and wound washout. VTE occurred in 3 of 219 patients (2 PE, 1 DVT) receiving Rivaroxaban, and 1 PE in a patient who did not receive any thromboprophylaxis. No patients prescribed Enoxaparin developed VTE. In the same period 2009 there were 21 confirmed PEs in 512 patients undergoing TKR. This was statistically significant (Chi squared test p=0.02). Prolonged oozing was noted in 3 patients receiving Enoxaparin, and 17 patients receiving Rivaroxaban. 6 patients treated with Rivaroxaban returned to theatre, 3 for continuous ooze, 2 for wound dehiscence and 1 for infection. During the same period in 2009, there was only 1 return to theatre for haematoma washout. (Chi squared test; p=0.02). Following the NICE guidelines, there is a reduction in the PE rate following TKR but there is an increase in the overall return to theatre rate

Abstract. Introduction. The Wells score is commonly used to assess the risk of proximal Deep Vein Thrombosis (DVT) following Knee Arthroplasty (KA). The National Institute for Health and Care Excellence (NICE) guidelines recommend an Ultrasound scan in patients with a Wells score of 2 points or more. We wanted to assess how often this protocol resulted in a scan being done and how many were negative. Methodology. Details of all postoperative Ultrasound scans performed up to 90 days were audited in a high-volume unit between 1st January 2016 and 31st December 2020. This included all Lower Limb Arthroplasty patients. Results. Out of a total of 4955 KA (4506 Total Knee Arthroplasty, 449 Unilateral Knee Arthroplasty), 449 (9.1%) had a total of 561 scans, with 17 (3.0%) scans demonstrating a proximal DVT. Thus 97.0% of Ultrasound scans were negative. Conclusion. The present NICE guidelines with the two-Level DVT Wells score are inappropriate for the management of suspected proximal DVT following KA. We propose that swelling that fails to reduce after 4 hours of elevation, or new swelling after a period of recumbent rest, would be more appropriate indications for a scan and negative scans should not be repeated without a change in symptoms. Unless there are pressing clinical indications, therapeutic anticoagulation should not commence in the absence of a diagnosis

Aims

The primary aim of the study was to perform an analysis to identify the cost per quality-adjusted life-year (QALY) of robot-assisted unicompartmental knee arthroplasty (rUKA) relative to manual total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) for patients with isolated medial compartment osteoarthritis (OA) of the knee. Secondary aims were to assess how case volume and length of hospital stay influenced the relative cost per QALY.