Lower extremities' postthrombotic syndrome after total knee arthroplasty.

BACKGROUND: Deep venous thrombosis (DVT) is a disease associated with high morbidity in 40-60% patients who underwent Total Knee Arthroplasty (TKA). Postthrombotic syndrome (PTS) is a common long-term complication that may develop within 6 months or more than 2 years after episode of DVT. OBJECTIVE: To examine the prevalence of PTS in patients who had history of previous DVT and non-previous DVT at least 2-year follow-up period after TKA. MATERIAL AND METHOD: Retrospective chart review was done. All patients who underwent TKA during October 2002-2005 were included. They were postoperatively assessed for PTS with Villalta score and duplex ultrasonography at > or =2 years. The confirmed diagnosis of DVT was done by contrast venography. RESULTS: 22 of 76 patients (56 previous DVT 20 non-previous DVT) had PTS based on the clinical assessment. The previous-DVT group had significantly higher risk to PTS (OR = 1.59; 95% CI: 1.294-1.949; p-value = 0.001). When diagnosed with duplex ultrasonography, 36 in 56 patients of previous-DVT group and 8 in 20 of non-previous-DVT group were found positive venous reflux. Most of venous reflux occurred at popliteal vein (77%) and posterior tibial vein (59%). CONCLUSION: After TKA, the patients who developed DVT had higher risk to PTS (OR = 1.588). Treatment of DVT may not decrease this risk. Prevention of DVT becomes an important approach to prevent PTS.

The prevalence of thrombophilia and venous thromboembolism in total knee arthroplasty.

BACKGROUND: Venous thromboembolism (VTE) is a common and potential serious complication in lower extremity surgeries, especially in hip and knee arthroplasty. Pulmonary embolism is one of the most fatal complications. The recognition of VTE in the lower limb has been considered as an indication for anticoagulation. Many studies have shown that thrombophilia is one factor of VTE and the most common causes are protein C, protein S and antithrombin III deficiency, factor V leiden and dysfibrinogenemia. VTE is a disease of Western populations because of well documentation of incidence and many studies about thrombophilia. In Thailand, the prevalence of VTE has been unclear. OBJECTIVE: The present prospective study evaluated the prevalence of thrombophilia and venous thromboembolism after total knee arthroplasty in patients who did not receive prophylactic treatment of VTE in Phramongkutklao Hospital. STUDY DESIGN: Descriptive prospective consecutive case studies. SETTING: The Department of Orthopedic Surgery, Phramongkutklao Hospital, Bangkok Thailand. MATERIAL AND METHOD: Blood sample was examined at 2-3 weeks before TKA for measuring the level of thrombophilia. Bilateral ascending contrast venography of the lower extremities was performed routinely between 6th-10th post operative days after total knee arthroplasty. RESULTS: The authors studied 100 patients, 94 primary TKA and 6 revisions TKA. Sixty-one (61%) were positive for deep vein thrombosis. Eleven patients with positive venograms showed bilateral DVT twelve (12%) had a proximal DVT one was protein C deficiency, nine were protein S deficiency, 18 were antithrombin III deficiency, and 36 were positive study for FDP(D-dimer), However, no one was found with factor V leiden. Odds ratio of protein S deficiency was 0.9506, Antithrombin III deficiency was 0.7376, and FDP(D-dimer) was 1.229. The protein C deficiency and factor V leiden was undetermined. CONCLUSION: Patients who have total knee arthroplasty performed are at high risk for deep venous thrombosis. Although fetal pulmonary embolism rarely occurs in Thai populations, mechanical prevention was routinely used and prophylactic regimen should be a part of management of patients who undergo total knee arthroplasty.

Incidence of deep vein thrombosis in postoperative hip fracture patients in Phramongkutklao Hospital.

BACKGROUND: There are many reports about deep vein thrombosis from Western regions but few reports are from Asian countries especially Thailand. OBJECTIVES: The purpose of the present study was to reveal the incidence of deep vein thrombosis in postoperative hip fracture patients. MATERIAL AND METHOD: Ninety six patients who had intertrochanteric fracture or femoral neck fracture were included. They had fixation or hemiarthroplasty performed according to their indications. Bilateral Venography was performed on the sixth to tenth day after surgery. RESULTS: The positive venography result was 47.9%. Only nine patients with positive results had signs and symptoms of deep veins thrombosis. Distal DVT was found in 43.5% of the positive group. Proximal DVT was 56.5%. No patients had symptoms of pulmonary embolism. CONCLUSION: The incidence of deep vein thrombosis in Thailand is the same as in Western countries. The prophylaxis regimen may become a part of the line of management in elderly patients with hip fracture. Further studies about the natural history or complications of deep vein thrombosis should be of concern.