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Screening for Deep Vein Thrombosis After Periacetabular Osteotomy in Adult Patients: Is It Necessary?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The periacetabular osteotomy has become a common procedure for treating symptomatic acetabular dysplasia. Like other major hip procedures, there is concern regarding the risk of associated venous thromboembolic disease. Nevertheless, there is limited information regarding the need for screening, and optimal prophylactic measures have not been established.

Questions/purposes

We sought to determine the frequency of thromboembolic events (deep vein thrombosis [DVT] and symptomatic pulmonary embolism [PE]) associated with the periacetabular osteotomy in in patients receiving aspirin and mechanical compression prophylaxis.

Methods

We performed a retrospective review of 134 adult patients (149 hips) treated with the periacetabular osteotomy during an 8-year period. During this period, 136 (91%) of the hips treated with a periacetabular osteotomy were screened within 1 week for DVT, whereas 13 (9%) could not be evaluated for various reasons. The mean age of the patients at the time of surgery was 30 years (range, 18–60 years), and no patients were lost to followup during the 4 to 6 months after surgery. The same thromboembolic prophylactic regimen was used for all patients. This consisted of 325 mg aspirin twice a day and compression stockings for 6 weeks and lower extremity pneumatic compression devices while hospitalized. Screening bilateral lower extremity ultrasonography was performed within 1 week (mean, 4 days) of the procedure to detect asymptomatic DVTs.

Results

Of the 134 patients, two patients (two hips) with negative postoperative screening ultrasounds presented at 14 and 38 days postoperatively with clinical symptoms of DVT. Repeat ultrasound confirmed this diagnosis in both cases. There were no symptoms of PE. Screening venous ultrasonography did not identify any DVTs during the early postoperative period before discharge. These two patients were treated with 3 to 6 months of warfarin anticoagulation. Neither patient had persistent symptoms related to the DVT.

Conclusions

These data indicate that the risk of symptomatic DVT associated with periacetabular osteotomy is low (1%) with use of aspirin and mechanical compression prophylaxis. Furthermore, routine postoperative screening did not detect any patients with an asymptomatic DVT.

Level of Evidence

Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Debbie Long, Angela Keith, and Geneva Baca for assistance with preparation of this manuscript.

Author information

Authors and Affiliations

  1. Vanderbilt Orthopaedic Institute, Nashville, TN, USA

    Gregory G. Polkowski MD, MSc

  2. Department of Orthopaedic Surgery, University of Kentucky School of Medicine, 125 E. Maxwell Street, Suite 021, Lexington, KY, 40508, USA

    Stephen T. Duncan MD

  3. Marshfield Clinic, Eau Claire, WI, USA

    Adam D. Bloemke MD

  4. Washington University School of Medicine, St Louis, MO, USA

    Perry L. Schoenecker MD & John C. Clohisy MD

Authors
  1. Gregory G. Polkowski MD, MSc
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  2. Stephen T. Duncan MD
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  3. Adam D. Bloemke MD
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  4. Perry L. Schoenecker MD
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  5. John C. Clohisy MD
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Corresponding author

Correspondence to Stephen T. Duncan MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Washington University School of Medicine, St Louis, MO, USA.

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Polkowski, G.G., Duncan, S.T., Bloemke, A.D. et al. Screening for Deep Vein Thrombosis After Periacetabular Osteotomy in Adult Patients: Is It Necessary?. Clin Orthop Relat Res 472, 2500–2505 (2014). https://doi.org/10.1007/s11999-014-3614-x

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  • DOI: https://doi.org/10.1007/s11999-014-3614-x

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