Skip to main content
SpringerLink
Log in

Risk factors and distribution of symptomatic venous thromboembolism in total hip and knee replacements: prospective study

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Venous thromboembolism (VTE) is a common complication of orthopaedic surgery in the industrialised world; though there may be variability between population groups. This study aims to define the incidence and risk factors for symptomatic VTE following primary elective total hip and knee arthoplasty surgery in a single centre in Eastern Europe.

Methods

This prospective study included 499 adult patients undergoing total hip and knee arthroplasty for symptomatic osteoarthritis over a two-year period at the Clinic of Orthopaedic Surgery and Traumatology, Belgrade.

Results

The overall rate of confirmed symptomatic VTE during hospitalisation was 2.6%. According to the univariate logistic regression, an age greater than 75 years (OR = 3.08; 95%CI = 1.01–9.65), a family history of VTE (OR = 6.61; 95% CI = 1.33–32.90), varicose veins (OR = 3.13; 95% CI = 1.03–9.48), and ischemic heart disease (OR = 4.93; 95% CI = 1.61–15.09) were significant risk factors for in-hospital VTE. A family history of VTE and ischemic heart disease were independent risk factors according to multivariate regression analysis. Preoperative initiation of pharmacological thromboprophylaxis (p = 0.03) and a longer duration of thromboprophylaxis (p = 0.001) were protective for postoperative DVT. Though thromboprophylaxis was safe, with very few patients suffering major haemorrhage or heparin-induced thrombocytopenia, there was a general reluctance by our local surgeons to use prolonged thromboprophylaxis.

Conclusion

VTE is common following hip and knee arthroplasty surgery. Orthopaedic patients with a family history of VTE, heart failure and coronary heart disease are at a considerable risk of thromboembolic complications in the postoperative period. There may be a role for preoperative thromboprophylaxis in addition to prolonged postoperative treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Heit JA (2008) The epidemiology of venous thromboembolism in the community. Arterioscler Thromb Vasc Biol 28:370–372

    Article  PubMed  CAS  Google Scholar 

  2. Fisher WD (2011) Impact of venous thromboembolism on clinical management and therapy after hip and knee arthroplasty. Can J Surg 54:344–351

    Article  PubMed  Google Scholar 

  3. Geerts WH, Bergquist D, Pineo G, Heit JA, Samama CM, Lassen MR et al (2008) Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133(6 Suppl):381S–453S

    Article  PubMed  CAS  Google Scholar 

  4. Deitelzweig SB, McKean SC, Amin AN, Brotman DJ, Jaffer AK, Spyropoulos AC (2008) Prevention of venous thromboembolism in the orthopedic surgery patient. Cleve Clin J Med 75(3):S27–S36

    Article  PubMed  Google Scholar 

  5. Eriksson IB, Kakkar KA, Turpie GA, Gent M, Bandel TJ, Homering M et al (2009) Oral rivaroxaban for the prevention of symptomatic venous thromboembolism after elective hip and knee replacement. J Bone Joint Surg 91-B:636–644

    Article  Google Scholar 

  6. Barrellier MT, Lebel B, Parienti JJ, Mismetti P, Dutheil JJ, Vielpeau C et al (2010) Short versus extended thromboprophylaxis after total knee arthroplasty: a randomized comparison. Thromb Res 6:e298–e304

    Article  Google Scholar 

  7. Sugano N, Miki H, Nakamura N, Aihara M, Yamamoto K, Ohzono K (2009) Clinical efficacy of mechanical thromboprophylaxis without anticoagulant drugs for elective hip surgery in an Asian population. J Arthroplasty 24:1254–1257

    Article  PubMed  Google Scholar 

  8. Eikelboom JW, Quinlan DJ, Douketis JD (2001) Extended-duration prophylaxis against venous thromboembolism after total hip or knee replacement: a meta-analysis of the randomized trials. Lancet 358:9–15

    Article  PubMed  CAS  Google Scholar 

  9. Memtsoudis GS, Besculides CM, Gaber L, Liu S, Gonzales Della Valle A (2009) Risk factors for pulmonary embolism after hip and knee arthroplasty: a population-based study. Int Orthop (SICOT) 33:1739–1745

    Article  Google Scholar 

  10. O’Donnell M, Linkins L-A, Kearon C, Julian J, Hirsh J (2003) Reduction of out-of-hospital symptomatic venous thromboembolism by extended thromboprophylaxis with low-molecular-weight heparin following elective hip arthroplasty. A systematic review. Arch Intern Med 163:1362–1366

    Article  PubMed  Google Scholar 

  11. Warvick D, Friedman RJ, Agnelli G, Gil-Garay E, Johnson K, FitzGerald G et al (2007) Insufficient duration of venous thromboembolism prophylaxis after total hip or knee replacment when compared with the time course of thromboembolic events. J Bone Joint Surg Br 89-B:799–807

    Article  Google Scholar 

  12. Samama CM, Vray M, Barre J, Fiessinger JN, Rosencher N, Lecompte T et al (2002) Extended venous thromboemblism prophylaxis after total hip replacement: a comparison of low- molecular-weight heparin with oral anticoagulant. Arch Intern Med 162:2191–2196

    Article  PubMed  CAS  Google Scholar 

  13. Mauermann WJ, Shilling AM, Zuo Z (2006) A comparison of neuroaxial block versus general anesthesia for elective total hip replacement: a meta analysis. Anesth Analg 103:1018–1025

    Article  PubMed  Google Scholar 

  14. Macfarlane AJR, Prasad GA, Chan VWS, Brull R (2009) Does regional anaesthesia improve outcome after total hip arthroplasty? A systematic review. Br J Anaesth 103:335–345

    Article  PubMed  CAS  Google Scholar 

  15. Kakkar AK, Brenner B, Dahl OE, Eriksson BI, Mouret P, Muntz J et al (2008) Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a doubleblind, randomised controlled trial. Lancet 372:29–37

    Article  Google Scholar 

  16. Fuji T, Fujita S, Takahiro Ochi T (2008) Fondaparinux prevents venous thromboembolism after joint replacement surgery in Japanese patients. Int Orthop 32:443–451

    Article  PubMed  Google Scholar 

  17. Samama CM, Ravaud P, Parent F, Barre J, Mertl P, Mismetti P (2007) Epidemiology of venous thromboembolism after lower limb arthroplasty: the FOTO study. J Thromb Haemost 5:2360–2367

    Article  PubMed  CAS  Google Scholar 

  18. Anderson FA Jr, Hirsh J, White K, Fitzgerald RH Jr, Hip and Knee Registry Investigators (2003) Temporal trends in prevention of venous thromboembolism following primary total hip or knee arthroplasty 1996-2001: findings from the Hip and Knee Registry. Chest 124(6 Suppl):349–356

    Google Scholar 

  19. Sen RK, Kumar A, Tripathy SK, Aggarwal S, Khandelwal N, Manoharan SR (2011) Risk of postoperative venous thromboembolism in Indian patients sustaining pelvi-acetabular injury. Int Orthop 35:1057–1063

    Article  PubMed  Google Scholar 

  20. Friedman RJ, Gallus AS, Cushner FD, FitzGerald G, Anderson FA Jr; Global Orthopaedic Registry Investigators (2008) Physician compliance with guidelines for deep-vein thrombosis prevention in total hip and knee arthroplasty. Curr Med Res Opin 24:87–97

    Google Scholar 

  21. Spyropoulos AC, Hussein M, Lin J, Battleman D (2009) Rates of symptomatic venous thromboembolism in US surgical patients: a retrospective administrative database study. J Thromb Thrombolysis 28:458–464

    Article  PubMed  Google Scholar 

  22. Mantilla CB, Horlocker TT, Schroeder DR, Berry DJ, Brown DL (2003) Risk factors for clinically relevant pulmonary embolism and deep venous thrombosis in patients undergoing primary hip or knee arthroplasty. Anesthesiology 99:552–560

    Article  PubMed  Google Scholar 

  23. Arcelus JI, Monreal M, Caprini JA, Guisado G, Jose Soto M, Nunez MJ et al (2008) Clinical presentation and time-course of postoperative venous thromboembolism: Results from the RIETE Registry. Thromb Haemost 99:46–551

    Google Scholar 

  24. White RH, Henderson MC (2002) Risk factors for venous thromboembolism after total hip or knee replacement surgery. Curr Opin Pulm Med 8:365–371

    Article  PubMed  Google Scholar 

  25. Eikelboom JW, Quinlan DJ, Douketis JD (2001) Extended-duration prophylaxis against venous thromboembolism after total hip or knee replacement: a meta-analysis of the randomized trials. Lancet 358:91–95

    Article  Google Scholar 

Download references

Acknowledgements

This work was supported by the Ministry of Science and Technological Development of Serbia, contract No. 175046, 2011–2014.

Author information

Authors and Affiliations

  1. Faculty of Medicine, Institute of Epidemiology, Belgrade, Serbia

    Ljiljana Markovic-Denic

  2. Clinic of Orthopaedic Surgery and Traumatology, Clinical Centre of Serbia, Belgrade, Serbia

    Kristina Zivkovic, Aleksandar Lesic & Marko Bumbasirevic

  3. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

    Aleksandar Lesic, Vesna Bumbasirevic, Emilija Dubljanin-Raspopovic & Marko Bumbasirevic

  4. Clinic of Anaesthesiology, Clinical Center of Serbia, Belgrade, Serbia

    Vesna Bumbasirevic

  5. Clinic for Physical, Medicine and Rehabilitation, Clinical Center of Serbia, Belgrade, Serbia

    Emilija Dubljanin-Raspopovic

Authors
  1. Ljiljana Markovic-Denic
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kristina Zivkovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aleksandar Lesic
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vesna Bumbasirevic
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Emilija Dubljanin-Raspopovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marko Bumbasirevic
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ljiljana Markovic-Denic.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Markovic-Denic, L., Zivkovic, K., Lesic, A. et al. Risk factors and distribution of symptomatic venous thromboembolism in total hip and knee replacements: prospective study. International Orthopaedics (SICOT) 36, 1299–1305 (2012). https://doi.org/10.1007/s00264-011-1466-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-011-1466-5

Keywords

Search

Navigation