The Research Of The Incidence Of Deep Venous Thrombosis Around Arthroplasty And Arthroscopy And The Thromboprophylaxis To Prevent It

Deep venous thrombosis(DVT)is a condition in which a blood clot forms in one or more of the deep veins in your legs.It is associated with pulmonary embolism(PE),which is a fatal disease because of its high morbidity and mortality in outpatients and inpatients,especially in hospitalized patient.DVT is a common complication in orthopedics,especially after major orthopedic surgery.The incidence of DVT,are in the range of 41%-85%after total knee arthroplasty(TKA)and 42%-57%after total hip arthroplasty(THA).There are a lot of risk factors of DVT after TKA and THA,such as age,gender,obesity,use of cement,tourniquet,transfusion and contraceptive.The diagnose of DVT depends on venography and ultrasonography commonly.The heterogeneity of the methods used to diagnose VTE has led to inconsistencies in the reported rates of VTE.Because of its accuracy and reliability,venography is the standard recommended screening method for asymptomatic DVT.In the past few years,we found some patients developing PE but with no DVT in the operated leg.This let us pay more attention in the contralateral leg.The incidence of VTE can be greatly reduced by the use of anticoagulant prophylaxic measures.The common anticoagulant drugs are warfarin,low molecular-weight heparin(LMWH),rivaroxaban,dabigatran and so on.The incidence of DVT and the rate of bleeding are the most common points they choose to compare.But the research of the size of DVT is rare.Arthroscopic knee surgeries are among the most common orthopaedic procedures.As the increasing of the number of arthroscopic knee procedures,the reports of associated complications become more and more.Recently,some cases in the death of PE have been reported,which attracting everyone's attention.Based on the above factors,we fist studied the incidence of DVT in the non-operated leg after primary major lower extremity arthroplasty using bilateral venography.244 patients undergoing TKA(n=119)or THA(n=125)were recruited for this study and had undergone bilateral venography 3-5 days after THA or TKA.DVT was diagnosed by venography in 42(17.2%)of the 244 patients.The incidences of DVT after TKA and after THA were approximately 22.7%and 12%.The total incidence of DVT in the contralateral leg was approximately 5.3%.All DVTs occurred in calf veins.Then we compared rivaroxaban with enoxaparin by measuring the size of DVT after TKA and THA.235 patients undergoing TKA(n=116)or THA(n=119)were enrolled.The length and maximum diameter of the thrombus and the number of involved veins(one or more)were measured and compared between the treatment groups.Thrombi longer than 5 cm or greater than 7 mm in maximum diameter were selected for analysis.The incidence of DVT and drainage did not differ between the treatment groups.The average length and average maximum diameter of the thrombi were 3.92 ± 2.49 cm and 5.21 ±2.69 mm in the rivaroxaban group and 4.97±5.06 cm and 7.61 ±2.95 mm in the enoxaparin group.Rivaroxaban and enoxaparin have a similar effect in decreasing the incidence of DVT after TKA.Rivaroxaban produces a greater restriction of the size of the thrombus and is a more economical option for the prevention of DVT after TKA.To establish a contemporary literature-based estimate of DVT incidence after knee arthroscopic surgery,we performed a meta-analysis of the English literature to assess the efficacy of any prophylaxis to prevent DVT after knee arthroscopic surgery.We calculated pooled proportions of postoperative DVT and proximal DVT.9 prospective uncontrolled studies and 4 RCTs were retrieved.The populations with LMWH to prevent DVT had a 0.1%-11.9%DVT incidence,averaging 1.8%(0.5%-5.7%).DVT incidence without prophylaxis varied from 1.8%to 41.2%,averaging 6.8%(3.5%-12.8%).The pooled incidence of DVT rate is 1.8%for studies with LMWH prophylaxis,and 6.8%for studies without prophylaxis.Patients who had LMWH as prophylaxis had a 73.5%and 87.5%relative risk reduction in developing DVT and proximal DVT respectively.To analyze the incidence of deep venous thrombosis(DVT)before knee arthroscopy in patients who had sustained high-energy knee injuries,we studied 64 patients who underwent arthroscopic knee surgery as a result of injury from a traffic accident or a high fall.Venography was performed on the injured leg of each patient before arthroscopy.The patients were divided into two groups based on whether they had DVT.Correlation analysis was performed to determine the factors associated with DVT.A total of 32(50%)of the 64 patients had venographic evidence of DVT.Of these DVTs,7 were proximal(10.9%).The D-dimer(DD)level was significantly higher in the DVT group,especially among the patients whose symptoms had persisted for more than 10 days.DVT is difficult to diagnose solely based on clinical symptoms,as some patients are symptomatic while others exhibit symptoms that could be attributed to trauma.At last we did a study to identify the incidence of and associated risk factors for deep venous thrombosis(DVT)after arthroscopic posterior cruciate ligament reconstruction(PCLR).128 patients were enrolled.Of the 128 patients studied,28(21.88%)developed DVT,4(3.13%)of which were proximal DVT cases.Older age,longer durations of tourniquet application,higher VAS scores and DD levels,and complex surgical procedures were all high risk factors for DVT after PCLR.Thus,routine thromboprophylaxis is recommended in these patients.