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Controversy: Should All Patients Undergoing TJA Receive Pre- and Postoperative Ultrasound Screening for Detection of DVT?

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Perioperative Medical Management for Total Joint Arthroplasty

Abstract

Venous thromboembolism represents a frequent complication following total joint arthroplasty (TJA). Many international guidelines for deep venous thrombosis (DVT) prophylaxis do not recommend a preoperative lower limb duplex ultrasound before total hip and knee arthroplasty. This study is aimed at determining whether a preoperative Doppler ultrasonographic screening is cost-effective as a DVT and pulmonary embolism prevention device. A series of 2,678 consecutive patients undergoing TJA received preoperative assessment for DVT by bilateral lower limbs color Doppler ultrasonography. The study group included 1,697 females (63.3 %) and 981 males (36.7 %): all patients were included regardless of absence of previous vascular symptoms. Assessment included examination of bilateral common femoral, superficial femoral, popliteal, anterior tibial and posterior tibial veins. Preoperative ultrasound screening highlighted the presence of DVTs in 120 patients (4.5 %). Those patients were withdrawn from the operative schedule and began DVT treatment with personalized doses of LMWH (low molecular weight heparin). Patients underwent TJA procedure once the preoperative Doppler ultrasonography revealed absence of DVT (minimum 3 months; maximum 6 months). This study discovered a preoperative asymptomatic DVT in a consistent number of patients just before undergoing TJA: without screening they were at risk of developing possible life-threatening perioperative pathologies. Therefore we consider it prudent to perform a preoperative Doppler ultrasonography to detect any pre-existing DVT, especially in patients who are considered to be at high risk.

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References

  • Andrews EJ, Fleischer C (2005) Sonography for deep venous thrombosis: current and future applications. Ultrasound Q 21:213–225

    Article  PubMed  Google Scholar 

  • Blann AD, Lip GYH (2006) Venous thromboembolism. BMJ 332:215–219

    Article  PubMed Central  PubMed  Google Scholar 

  • Brookenthal KR, Freedman KB, Lotke PA et al (2001) A meta-analysis of thromboembolic prophylaxis in total knee arthroplasty. J Arthroplasty 16:293–300

    Article  CAS  PubMed  Google Scholar 

  • Chotanaphuthi T, Heebthamai D, Taweewuthisub W, Thiengwittayaporn S, Roschan S, Kanchanaroek K (2009) Prediction of deep vein thrombosis after total knee arthroplasty with preoperative D-dimer plasma measurement. J Med Assoc Thai 92(Suppl 6):S6–S10

    PubMed  Google Scholar 

  • Clagett GP, Anderson FA, Heit J et al (1995) Prevention of venous thromboembolism. Chest 108:312S–334S

    Article  CAS  PubMed  Google Scholar 

  • Clarke MT, Green JS, Harper WM et al (1997) Screening for deep vein thrombosis after total hip and knee replacement without prophylaxis. J Bone Joint Surg Br 79:787–791

    Article  CAS  PubMed  Google Scholar 

  • Cohen AT, Agnelli G, Anderson FA et al (2007) Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 98:756–764

    CAS  PubMed  Google Scholar 

  • Cronan JJ, Dorfman GS, Scola FH et al (1987) Deep venous thrombosis: US assessment using vein compression. Radiology 162:191–194

    Article  CAS  PubMed  Google Scholar 

  • Davidson BL, Elliott CG, Lensing AW (1992) Low accuracy of color Doppler ultrasound in the detection of proximal leg vein thrombosis in asymptomatic high-risk patients. The RD Heparin Arthroplasty Group. Ann Intern Med 117:735–738

    Article  CAS  PubMed  Google Scholar 

  • Dermody M, Alessi-Chinetti J, Iafrati MD, Estes JM (2011) The utility of screening for deep venous thrombosis in asymptomatic, non-ambulatory neurosurgical patients. J Vasc Surg 53(5):1309–1315. doi:10.1016/j.jvs.2010.10.115. Epub 2011 Jan 7

    Article  PubMed  Google Scholar 

  • Doouss TW (1976) The clinical significance of venous thrombosis of the calf. Br J Surg 63:377–378

    Article  CAS  PubMed  Google Scholar 

  • Eichinger S, Minar E, Bialonczyk C et al (2003) D-dimer levels and risk of recurrent venous thromboembolism. JAMA 290:1071–1074

    Article  CAS  PubMed  Google Scholar 

  • Eichinger S, Heinze G, Jandeck LM, Kyrle PA (2010) Risk assessment of recurrence in patients with unprovoked deep vein thrombosis or pulmonary embolism: the Vienna prediction model. Circulation 121:1630–1636

    Article  PubMed  Google Scholar 

  • Francis CW, Pellegrini VD Jr, Totterman S et al (1997) Prevention of deep-vein thrombosis. J Bone Joint Surg Am 9:1365–1372

    Google Scholar 

  • Geerts WH, Bergqvist D, Pineo GF et al (2008) Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 133:381S–453S

    Article  CAS  PubMed  Google Scholar 

  • Giannini M, Rollo HA, Maffei FH, Carvalho LR (2008) Advances in ultrasound techniques improve early detection of deep vein thrombosis. Int Angiol 27(6):466–474

    CAS  PubMed  Google Scholar 

  • Goodacre S, Sampson F, Stevenson M, Wailoo A, Sutton A, Thomas S, Locker T, Ryan A (2006a) Measurement of the clinical and cost-effectiveness of non-invasive diagnostic testing strategies for deep vein thrombosis. Health Technol Assess 10(15):1–168, iii–iv

    CAS  PubMed  Google Scholar 

  • Goodacre S, Stevenson M, Wailoo A, Sampson F, Sutton AJ, Thomas S (2006b) How should we diagnose suspected deep-vein thrombosis? QJM 99(6):377–388

    Article  CAS  PubMed  Google Scholar 

  • Gordon H, Guyatt EA, Crowther M et al (2012) Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):1S. doi:10.1378/chest.1412S1

    Google Scholar 

  • Grady-Benson JC, Oishi CS, Hanson PB et al (1994) Postoperative surveillance for deep vein thrombosis with duplex ultrasonography after total knee arthroplasty. J Bone Joint Surg Am 11:1649–1657

    Google Scholar 

  • Hansson PO, Sorbo J, Eriksson H (2000) Recurrent venous thromboembolism after deep vein thrombosis: incidence and risk factors. Arch Intern Med 160:769–774

    Article  CAS  PubMed  Google Scholar 

  • Heit JA, Cohen AT, Anderson FA, On behalf of the VTE Impact Assessment Group (2005) Estimated annual number of incident and recurrent, non-fatal and fatal venous thromboembolism (VTE) events in the US. Blood 106:910A

    Google Scholar 

  • Ko PS, Chan WF, Siu TH et al (2003) Duplex ultrasonography after total hip or knee arthroplasty. Int Orthop 27:168–171

    CAS  PubMed Central  PubMed  Google Scholar 

  • Kyrle PA, Eichinger S (2005) Deep vein thrombosis. Lancet 365:1163–1174

    Article  PubMed  Google Scholar 

  • Lieberman JR, Pellegrini VD (1999) Orthopaedic knowledge update 6. American Academy of Orthopaedic Surgeon, Rosemont

    Google Scholar 

  • Lohr JM, James KV, Deshmukh RM et al (1995) Calf vein thrombi are not a benign finding. Am J Surg 170:86–90

    Article  CAS  PubMed  Google Scholar 

  • Lotke PA, Steinbery ME, Ecker ML (1994) Significance of deep vein thrombosis in the lower extremity after total joint arthroplasty. Clin Orthop 299:25–30

    PubMed  Google Scholar 

  • Masuda EM, Kessler DM, Kistner RL et al (1998) The natural history of calf vein thrombosis: lysis of thrombi and development of reflux. J Vasc Surg 28(1):67–73; discussion 73–74

    Article  CAS  PubMed  Google Scholar 

  • McKenna R, Bachmann F, Kaushal SP et al (1976) Thromboembolic disease in patients undergoing total knee replacement. J Bone Joint Surg Am 58:928–932

    CAS  PubMed  Google Scholar 

  • Murray DW, Britton AR, Bulstrode CJ (1996) Thromboprophylaxis and death after total hip replacement. J Bone Joint Surg Br 78:863–870

    Article  CAS  PubMed  Google Scholar 

  • National Institutes of Health Consensus Development Conference statement (1986) Prevention of venous and pulmonary thromboembolism. JAMA 256:744–749

    Article  Google Scholar 

  • Pabinger I, Ay C (2009) Biomarkers and venous thromboembolism. Arterioscler Thromb Vasc Biol 29:332–336

    Article  CAS  PubMed  Google Scholar 

  • Parvizi J, Ghanem E, Joshi A et al (2007) Does “excessive” anticoagulation predispose to periprosthetic infection? J Arthroplasty 22(6 Suppl 2):24–28

    Article  PubMed  Google Scholar 

  • Patel AP, Koltz MT, Sansur CA, Gulati M, Hamilton DK (2013) An analysis of deep vein thrombosis in 1277 consecutive neurosurgical patients undergoing routine weekly ultrasonography. J Neurosurg 118(3):505–509. Epub 2012 Dec 14

    Article  PubMed  Google Scholar 

  • Planes A, Samama MM, Lensing AW et al (1999) Prevention of deep vein thrombosis after hip replacement. Thromb Haemost 81:22–25

    CAS  PubMed  Google Scholar 

  • Prandoni P, Noventa F, Ghirarduzzi A et al (2007) The risk of recurrent venous thromboembolism after discontinuing anticoagulation in patients with acute proximal deep vein thrombosis or pulmonary embolism. A prospective cohort study in 1,626 patients. Haematologica 92:199–205

    Article  PubMed  Google Scholar 

  • Saad WE, Saad N (2007) Computer tomography for venous thromboembolic disease. Radiol Clin North Am 45:423–445

    Article  PubMed  Google Scholar 

  • Shimoyama Y, Sawai T, Tatsumi S, Nakahira J, Oka M, Nakajima M, Jotoku T, Minami T (2012) Perioperative risk factors for deep vein thrombosis after total hip arthroplasty or total knee arthroplasty. J Clin Anesth 24(7):531–536. Epub 2012 Sep 21

    Article  PubMed  Google Scholar 

  • Sisodia G, Garnet Fernando WS, Melton C et al. (2013) The incidence of pre-operative asymptomatic DVT among patients awaiting total knee arthroplasty or total hip arthroplasty. http://www.nlg.nhs.uk/services/radiology/The.incidence.of.preop.DVT.in.patients.awaiting.TKR.and.THR.pdf. Accessed 22 Dec 2013

  • Stern JB, Abehsera M, Grenet D et al (2002) Detection of pelvic vein thrombosis by magnetic resonance angiography in patients with acute pulmonary embolism and normal lower limb compression ultrasonography. Chest 122:115–121

    Article  PubMed  Google Scholar 

  • Stulberg BN, Insall JN, Williams GW et al (1984) Deep vein thrombosis following total knee replacement. An analysis of six hundred and thirty-eight arthroplasties. J Bone Joint Surg Am 66:194–201

    CAS  PubMed  Google Scholar 

  • Turpie AGG, Chin BSP, Lip GYH (2002) Venous thromboembolism: pathophysiology, clinical features, and prevention. BMJ 325:887–890

    Article  PubMed Central  PubMed  Google Scholar 

  • Vormittag R, Panzer S, Ay C et al (2007) Soluble P-selectin and thrombosis risk of patients with a persistent lupus anticoagulant in a prospective study. Haematologica 92:327. Abstract 0878

    Google Scholar 

  • Wells PS, Anderson DR, Bormanis J et al (1997) Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet 350:1795–1798

    Article  CAS  PubMed  Google Scholar 

  • Westrich GH, Haas SB, Mosca P et al (2000) Meta-analysis of thromboembolic prophylaxis after total knee arthroplasty. J Bone Joint Surg Br 82(6):795–800

    Article  CAS  PubMed  Google Scholar 

  • Zhu T, Martinez I, Emmerich J (2009) Venous thromboembolism: risk factors for recurrence. Arterioscler Thromb Vasc Biol 29:298–310

    Article  CAS  PubMed  Google Scholar 

  • Zhu R, Wei S, Wu S, Gong H, Chen X (2010) Early diagnosis of lower limb deep vein thrombosis after major orthopedic surgeries. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 24(6):730–734

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Center of Excellence for Articular Replacement (Centro Eccellenza Sostituzioni Articolari Toscana, CESAT), University of Florence, Florence, Italy

    Massimiliano Marcucci, Pier Francesco Indelli & Angelo Graceffa

  2. “In Cammino” Foundation, Piazza Lavagnini 1, Fucecchio, Florence, 50054, Italy

    Massimiliano Marcucci, Pier Francesco Indelli & Angelo Graceffa

  3. The Breyer Center for Overseas Study, Stanford University in Florence, Via de’ Bardi 36, Florence, 50125, Italy

    Pier Francesco Indelli & Xuan-Phien Pham

  4. Hip and Knee Arthroplasty and Arthroscopic Unit, Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano Milan, 20089, Italy

    Marco Scardino, Antonino Gurgone & Federica Martorelli

Authors
  1. Massimiliano Marcucci
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  2. Pier Francesco Indelli
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  3. Angelo Graceffa
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  4. Xuan-Phien Pham
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  5. Marco Scardino
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  6. Antonino Gurgone
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  7. Federica Martorelli
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Corresponding authors

Correspondence to Pier Francesco Indelli , Marco Scardino or Marco Scardino .

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Editors and Affiliations

  1. Humanitas Clinical and Research Center, Milan, Italy

    Andrea Baldini

  2. San Donato Hospital, Arezzo, Italy

    Patrizio Caldora

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Marcucci, M. et al. (2015). Controversy: Should All Patients Undergoing TJA Receive Pre- and Postoperative Ultrasound Screening for Detection of DVT?. In: Baldini, A., Caldora, P. (eds) Perioperative Medical Management for Total Joint Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-319-07203-6_8

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  • DOI: https://doi.org/10.1007/978-3-319-07203-6_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-07202-9

  • Online ISBN: 978-3-319-07203-6

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