ABSTRACT
PURPOSE: To establish the incidence of venous thromboembolic complications as detected by bilateral complete compression ultrasonography (CCUS) after arthroscopic anterior cruciate ligament (ACL) reconstruction without thromboprophylaxis. METHODS: We performed a prospective cohort study to establish the incidence of venous thromboembolic complications after arthroscopic ACL reconstruction, as detected by bilateral CCUS at 14 days (range, 11 to 17 days) postoperatively. One hundred consecutive patients underwent bilateral extended ultrasonography. RESULTS: One hundred predominantly European patients with a mean age of 30 ± 10 years and mean body mass index of 25 ± 4 underwent ACL reconstruction with a mean operative duration of 68 ± 23 minutes and a tourniquet time of 76 ± 23 minutes. In 84% of patients an autologous hamstring graft was used, in 14% a bone-patellar tendon-bone graft was used, and 2 patients received an allograft. Of 100 patients, 9 (incidence, 9%; 95% confidence interval, 4.2 to 16.4) showed asymptomatic proximal or distal deep vein thrombosis on CCUS, of whom 4 (incidence, 4%; 95% confidence interval, 1.1 to 9.9) were symptomatic. A nonfatal pulmonary embolus developed in 1 patient during the 8-week follow-up period. CONCLUSIONS: This study shows that the incidence of venous thromboembolism after arthroscopic ACL reconstruction is relatively high; a 9% incidence of asymptomatic proximal or distal deep vein thrombosis was found, whereas 4% of patients were symptomatic. Further research is recommended to assess the need for thromboprophylaxis in patients undergoing ACL reconstruction, especially when risk factors are present. LEVEL OF EVIDENCE: Level IV, case series.
Subject(s)
Anterior Cruciate Ligament Reconstruction/adverse effects , Venous Thrombosis/etiology , Adult , Age Factors , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament Reconstruction/methods , Arthroscopy , Body Mass Index , Cohort Studies , Female , Humans , Incidence , Male , Middle Aged , Operative Time , Prospective Studies , Risk Factors , Tendons/transplantation , Transplantation, Homologous , Ultrasonography , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/epidemiologyABSTRACT
BACKGROUND AND PURPOSE: Previous surveys in the Netherlands have revealed that guidelines regarding orthopedic thromboprophylaxis were not followed and that a wide variation in protocols exists. This survey was performed to assess the current use of thromboprophylactic modalities and to compare it with the results of a previous survey. METHODS: All departments of orthopedic surgery in the Netherlands were sent a follow-up survey on venous thromboprophylaxis, and the data obtained were compared to the results of a survey performed 5 years earlier. RESULTS: All departments used pharmacological thromboprophylaxis following arthroplasties of the hip and knee. Low-molecular-weight heparin (LMWH) was used most frequently (79%) of the departments, followed by fondaparinux (13%). 5 years earlier, coumarin treatment was the predominant prophylaxis (79%). All departments prescribed pharmacological prophylaxis after femoral and tibial fractures; 78% used LMWH. Prophylaxis was continued for 6 weeks in 85% of cases. LMWH treatment was initiated on the day before surgery in 31% of cases (65% in the previous survey), perioperatively in 55%, and in the evening following surgery in 24%. In general, for daycare surgery and arthroscopies either no prophylaxis was given or a LMWH was given for 1 day. After anterior cruciate ligament reconstruction, 94% of departments prescribed some form of pharmacological prophylaxis. INTERPRETATION: The use of pharmacological prophylaxis after arthroplasty of the hip and knee and also after fracture surgery around the hip and knee is common practice in the Netherlands. In 5 years, the widely used coumarin derivates have been largely replaced with LMWH.
Subject(s)
Anticoagulants/administration & dosage , Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Fracture Fixation, Internal , Thrombosis/prevention & control , Anterior Cruciate Ligament/surgery , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Coumarins/administration & dosage , Follow-Up Studies , Fondaparinux , Fracture Fixation, Internal/adverse effects , Guideline Adherence , Heparin, Low-Molecular-Weight/administration & dosage , Humans , Netherlands , Polysaccharides/administration & dosage , Practice Patterns, Physicians' , Stockings, Compression , Surveys and QuestionnairesABSTRACT
BACKGROUND: The advantages of uncemented and cemented components in hip arthroplasty have been subject of debate. We have studied on a hemiprosthesis, which can be optionally implanted with or without cement. Since the stem geometry and surface in cemented arthroplasty differs from the uncemented one and cannot be fused into one general design, we hypothesised that this hemiprosthesis used without cement has a considerable high revision rate, based on aseptic loosening. METHODS: A hemiprosthesis, which is designed for both cemented and uncemented fixation, was used (Conquest, Smith&Nephew). Preoperatively, the choice of whether to use cement or not was based on the shape and bone quality of the femoral canal. Revision rate and indication, mortality, perioperative complications and radiographic features of 151 consecutive hips in 146 patients were evaluated. RESULTS: Twenty-three stems (15%) were implanted with cement and 128 (85%) without. After a mean follow-up of 2 years, a revision rate of 8.6% and a survival percentage of 90% (CI 85-95) were observed. Twelve uncemented stems warranted revision, compared with one cemented stem. Revision because of aseptic loosening was necessary in 7 (6%) stems, all uncemented. No differences in operation-related mortality and morbidity were observed. CONCLUSION: Because of the rather high revision rate, the authors advice not to use this hemiprosthesis without cement.
