Clinical Orthopaedics and Related Research®

, Volume 467, Issue 8, pp 2196–2199 | Cite as

Case Reports: Heritable Thrombophilia Associated with Deep Venous Thrombosis after Shoulder Arthroscopy

  • Santiago L. Bongiovanni
  • Maximiliano Ranalletta
  • Agustin Guala
  • Gaston D. Maignon
Case Reports


Thromboembolic complications after shoulder arthroscopy are rare and their cause has not been well determined. Heritable thrombophilia has been studied in relation to numerous clinical conditions, and it has been associated with thromboembolic complications after some orthopaedic surgeries, especially after total hip or knee arthroplasty. We report three patients who had deep vein thrombosis develop after shoulder arthroscopy. All three tested positive for heritable thrombophilia, a condition undetected until this complication occurred. This report highlights the possibility that unrecognized coagulation disorders might seriously influence the clinical outcome of minimally invasive surgery. We suggest heritable thrombophilia is a possible risk factor for or etiology of deep vein thrombosis after shoulder arthroscopy.


  1. 1.
    Balasa VV, Gruppo RA, Glueck CJ, Wang P, Roy DR, Wall EJ, Mehlman CT, Crawford AH. Legg-Calvé-Perthes disease and thrombophilia. J Bone Joint Surg Am. 2004;86:2642–2647.PubMedGoogle Scholar
  2. 2.
    Bernardi E, Pesavento R, Prandoni P. Upper extremity deep venous thrombosis. Semin Thromb Hemost. 2006;32:729–736.PubMedCrossRefGoogle Scholar
  3. 3.
    Bertina RM, Rosendaal FR. Venous thrombosis: the interaction of genes and environment. N Engl J Med. 1998;338:1840–1841.PubMedCrossRefGoogle Scholar
  4. 4.
    Brenner B. Inherited thrombophilia and pregnancy loss. Thromb Haemost. 1999;82:634–640.PubMedGoogle Scholar
  5. 5.
    Brislin KJ, Field LD, Savoie FH 3rd. Complications after arthroscopic rotator cuff repair. Arthroscopy. 2007;23:124–128.PubMedGoogle Scholar
  6. 6.
    Burkhart SS. Deep venous thrombosis after shoulder arthroscopy. Arthroscopy. 1990;6:61–63.PubMedGoogle Scholar
  7. 7.
    Ciocon JO, Galindo-Ciocon D. Arm edema, subclavian thrombosis, and pacemakers: a case report. Angiology. 1998;49:315–319.PubMedCrossRefGoogle Scholar
  8. 8.
    Cortes ZE, Hammerman SM, Gartsman GM. Pulmonary embolism after shoulder arthroscopy: could patient positioning and traction make a difference? J Shoulder Elbow Surg. 2007;16:e16–e17.PubMedCrossRefGoogle Scholar
  9. 9.
    Creighton RA, Cole BJ. Upper extremity deep venous thrombosis after shoulder arthroscopy: a case report. J Shoulder Elbow Surg. 2007;16:e20–e22.PubMedCrossRefGoogle Scholar
  10. 10.
    Crowell DL. Effort thrombosis of the subclavian and axillary veins: review of the literature and case report with two-year follow-up with venography. Ann Intern Med. 1960;52:1337–1343.PubMedGoogle Scholar
  11. 11.
    Cullison TR, Muldoon MP, Gorman JD, Goff WB. The incidence of deep venous thrombosis in anterior cruciate ligament reconstruction. Arthroscopy. 1996;12:657–659.PubMedGoogle Scholar
  12. 12.
    Demers C, Marcoux S, Ginsberg JS, Laroche F, Cloutier R, Poulin J. Incidence of venographically proved deep vein thrombosis after knee arthroscopy. Arch Intern Med. 1998;158:47–50.PubMedCrossRefGoogle Scholar
  13. 13.
    De Stefano V, Finazzi G, Mannucci PM. Inherited thrombophilia: pathogenesis, clinical syndromes, and management. Blood. 1996;87:3531–3544.PubMedGoogle Scholar
  14. 14.
    Egeberg O. Inherited antithrombin deficiency causing thrombophilia. Thromb Diath Haemorrh. 1965;13:516–530.PubMedGoogle Scholar
  15. 15.
    Ellis MH, Manor Y, Witz M. Risk factors and management of patients with upper limb deep vein thrombosis. Chest. 2000;117:43–46.PubMedCrossRefGoogle Scholar
  16. 16.
    Franco RF, Reitsma PH. Genetic risk factors of venous thrombosis. Hum Genet. 2001;109:369–384.PubMedCrossRefGoogle Scholar
  17. 17.
    Frosst P, Blom HJ, Milos R, Goyette P, Sheppard CA, Matthews RG, Boers GJ, den Heijer M, Kluijtmans LA, van den Heuvel LP, et al. A candidate genetic risk factor for vascular disease: a common mutation in methylenetetrahydrofolate reductase. Nat Genet. 1995;10:111–113.PubMedCrossRefGoogle Scholar
  18. 18.
    Glueck CJ, Bell H, Vadlamani L, Gupta A, Fontaine RN, Wang P, Stroop D, Gruppo R. Heritable thrombophilia and hypofibrinolysis: possible causes of retinal vein occlusion. Arch Ophthalmol. 1999;117:43–49.PubMedGoogle Scholar
  19. 19.
    Glueck CJ, Fontaine RN, Gruppo R, Stroop D, Sieve-Smith L, Tracy T, Wang P. The plasminogen activator inhibitor-1 gene, hypofibrinolysis, and osteonecrosis. Clin Orthop Relat Res. 1999;366:133–146.PubMedCrossRefGoogle Scholar
  20. 20.
    Glueck CJ, Freiberg RA, Wang P. Heritable thrombophilia-hypofibrinolysis and osteonecrosis of the femoral head. Clin Orthop Relat Res. 2008;466:1034–1040.PubMedCrossRefGoogle Scholar
  21. 21.
    Hendler MF, Meschengieser SS, Blanco AN, Alberto MF, Salviu MJ, Gennari L, Lazzari MA. Primary upper-extremity deep vein thrombosis: high prevalence of thrombophilic defects. Am J Hematol. 2004;76:330–337.PubMedCrossRefGoogle Scholar
  22. 22.
    Holm J, Zoller B, Svensson PJ, Berntorp E, Erhardt L, Dahlback B. Myocardial infarction associated with homozygous resistance to activated protein C. Lancet. 1994;344:952–953.PubMedCrossRefGoogle Scholar
  23. 23.
    Horattas MC, Wright DJ, Fenton AH, Evans DM, Oddi MA, Kamienski RW, Shields EF. Changing concepts of deep venous thrombosis of the upper extremity: report of a series and review of the literature. Surgery. 1988;104:561–567.PubMedGoogle Scholar
  24. 24.
    Jordan FL, Nandorff A. The familial tendency in thrombo-embolic disease. Acta Med Scand. 1956;156:267–275.PubMedGoogle Scholar
  25. 25.
    Keats AS. The ASA classification of physical status: a recapitulation. Anesthesiology. 1978;49:233–236.PubMedCrossRefGoogle Scholar
  26. 26.
    Kommareddy A, Zaroukian MH, Hassouna HI. Upper extremity deep venous thrombosis. Semin Thromb Hemost. 2002;28:89–99.PubMedCrossRefGoogle Scholar
  27. 27.
    Kupferminc MJ, Eldor A, Steinman N, Many A, Bar-Am A, Jaffa A, Fait G, Lessing JB. Increased frequency of genetic thrombophilia in women with complications of pregnancy. N Engl J Med. 1999;340:9–13.PubMedCrossRefGoogle Scholar
  28. 28.
    Levine JS, Branch DW, Rauch J. The antiphospholipid syndrome. N Engl J Med. 2002;346:752–763.PubMedCrossRefGoogle Scholar
  29. 29.
    Madonna P, de Stefano V, Coppola A, Cirillo F, Cerbone AM, Orefice G, Di Minno G. Hyperhomocysteinemia and other inherited prothrombotic conditions in young adults with a history of ischemic stroke. Stroke. 2002;33:51–56.PubMedCrossRefGoogle Scholar
  30. 30.
    Mantilla CB, Horlocker TT, Schroeder DR, Berry DJ, Brown DL. Risk factors for clinically relevant pulmonary embolism and deep venous thrombosis in patients undergoing primary hip or knee arthroplasty. Anesthesiology. 2003;99:552-560; discussion 555A.PubMedCrossRefGoogle Scholar
  31. 31.
    Martinelli I, Mannucci PM, De Stefano V, Taioli E, Rossi V, Crosti F, Paciaroni K, Leone G, Faioni EM. Different risks of thrombosis in four coagulation defects associated with inherited thrombophilia: a study of 150 families. Blood. 1998;92:2353–2358.PubMedGoogle Scholar
  32. 32.
    Mont MA, Jones LC, Rajadhyaksha AD, Shuler MS, Hungerford DS, Sieve-Smith L, Wang P, Cordista AG, Glueck CJ. Risk factors for pulmonary emboli after total hip or knee arthroplasty. Clin Orthop Relat Res. 2004;422:154–163.PubMedCrossRefGoogle Scholar
  33. 33.
    Pezzini A, Del Zotto E, Archetti S, Negrini R, Bani P, Albertini A, Grassi M, Assanelli D, Gasparotti R, Vignolo LA, Magoni M, Padovani A. Plasma homocysteine concentration, C677T MTHFR genotype, and 844ins68 bp CBS genotype in young adults with spontaneous cervical artery dissection and atherothrombotic stroke. Stroke. 2002;33:664–669.PubMedCrossRefGoogle Scholar
  34. 34.
    Pola E, Flex A, Papaleo P, Gaetani E, Delcogliano A, Pola P. Deep venous thrombosis and pulmonary embolism after knee arthroscopy in athletes carrying the thrombophilic factor lupus anticoagulant. Arthroscopy. 2005;21:103–107.PubMedCrossRefGoogle Scholar
  35. 35.
    Polzhofer GK, Petersen W, Hassenpflug J. Thromboembolic complication after arthroscopic shoulder surgery. Arthroscopy. 2003;19:E129–E132.PubMedGoogle Scholar
  36. 36.
    Rosendaal FR. Risk factors for venous thrombotic disease. Thromb Haemost. 1999;82:610–619.PubMedGoogle Scholar
  37. 37.
    Salvati EA, Della Valle AG, Westrich GH, Rana AJ, Specht L, Weksler BB, Wang P, Glueck CJ. The John Charnley Award. Heritable thrombophilia and development of thromboembolic disease after total hip arthroplasty. Clin Orthop Relat Res. 2005;441:40–55.PubMedCrossRefGoogle Scholar
  38. 38.
    Schippinger G, Wirnsberger GH, Obernosterer A, Babinski K. Thromboembolic complications after arthroscopic knee surgery: incidence and risk factors in 101 patients. Acta Orthop Scand. 1998;69:144–146.PubMedCrossRefGoogle Scholar
  39. 39.
    Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. SLAP lesions of the shoulder. Arthroscopy. 1990;6:274–279.PubMedCrossRefGoogle Scholar
  40. 40.
    Verso M, Agnelli G, Kamphuisen PW, Ageno W, Bazzan M, Lazzaro A, Paoletti F, Paciaroni M, Mosca S, Bertoglio S. Risk factors for upper limb deep vein thrombosis associated with the use of central vein catheter in cancer patients. Intern Emerg Med. 2008;3:117–122.PubMedCrossRefGoogle Scholar
  41. 41.
    Wahlander K, Larson G, Lindahl TL, Andersson C, Frison L, Gustafsson D, Bylock A, Eriksson BI. Factor V Leiden (G1691A) and prothrombin gene G20210A mutations as potential risk factors for venous thromboembolism after total hip or total knee replacement surgery. Thromb Haemost. 2002;87:580–585.PubMedGoogle Scholar
  42. 42.
    Westrich GH, Weksler BB, Glueck CJ, Blumenthal BF, Salvati EA. Correlation of thrombophilia and hypofibrinolysis with pulmonary embolism following total hip arthroplasty: an analysis of genetic factors. J Bone Joint Surg Am. 2002;84:2161–2167.PubMedGoogle Scholar
  43. 43.
    White RH, Zhou H, Romano PS. Incidence of symptomatic venous thromboembolism after different elective or urgent surgical procedures. Thromb Haemost. 2003;90:446–455.PubMedGoogle Scholar
  44. 44.
    Wirth T, Schneider B, Misselwitz F, Lomb M, Tuylu H, Egbring R, Griss P. Prevention of venous thromboembolism after knee arthroscopy with low-molecular weight heparin (reviparin): results of a randomized controlled trial. Arthroscopy. 2001;17:393–399.PubMedCrossRefGoogle Scholar
  45. 45.
    Woolson ST, Zehnder JL, Maloney WJ. Factor V Leiden and the risk of proximal venous thrombosis after total hip arthroplasty. J Arthroplasty. 1998;13:207–210.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2009

Authors and Affiliations

  • Santiago L. Bongiovanni
    • 1
  • Maximiliano Ranalletta
    • 1
  • Agustin Guala
    • 1
  • Gaston D. Maignon
    • 1
  1. 1.Instituto de OrtopediaHospital Italiano de Buenos AiresBuenos AiresArgentina

Personalised recommendations