Are Bilateral Total Joint Arthroplasty Patients at a Higher Risk of Developing Pulmonary Embolism Following Total Hip and Knee Surgery?

ArticleinThe Journal of arthroplasty 29(5) · November 2013with14 Reads
DOI: 10.1016/j.arth.2013.11.001 · Source: PubMed
Abstract
Despite developments in prophylactic methods, venous thromboembolism (VTE) continues to be a serious complication following total joint arthroplasty. The new AAOS/ACCP guidelines on preventing pulmonary embolism (PE) after total hip/knee arthroplasty (THA/TKA) do not make specific recommendations for bilateral vs. unilateral procedures. In-patient PE rates were examined for patients undergoing unilateral or simultaneous bilateral TKA/THA at our institution in 2011. Of the 7,437 THA/TKA surgeries completed at our institution in 2011, 36 patients suffered from PE (0.48%). The rate of PE for unilateral TKA was 0.61% vs. 1.87% for bilateral (P<0.001) and for unilateral THA was 0.17% vs. 0.52% for bilateral THA. Despite patients being screened before being cleared to undergo bilateral THA/TKA, they remain at higher risk for VTE.
    • "As there are no standard patient selection protocols for one-stage procedure, it is the individuals' surgeons experience to make the right decision. One of the main reasons for death in patients undergoing one-stage procedure is pulmonary embolism [39,[46][47][48][49]. Literature from the Swedish Knee Arthroplasty Register [34] reported a 3.77 times higher mortality risk for one-stage procedure, which is resultant with the use of a tourniquet and cementing techniques [16, 50] . "
    [Show abstract] [Hide abstract] ABSTRACT: BACKGROUND: When patient presents bilateral degenerative knee osteoarthritis, one-stage or two-stage total knee arthroplasty (TKA) remains controversial at present. OBJECTIVE: To compare the outcomes of one-stage and two-stage bilateral TKA for bilateral knee arthritis. METHODS: Patients with bilateral knee arthritis were treated in the First Affiliated Hospital of Soochow University in China from January 2005 to December 2008. They were assigned to one-stage group (n=68) and two-stage group (n=71). These patients were subjected to one-stage and two-stage bilateral TKA using Gemini MK II total knee system. RESULTS AND CONCLUSION: Compared to two-stage group, operation time and length of hospital stage were shorter, mean blood transfusion was larger, and hospital charges were lower in the one-stage group. However, no significant differences in postoperative knee function, complications, and patients’ satisfaction were detected between the one-stage and two-stage groups. No osteolysis was observed surrounding the prosthesis during final follow-up. These data confirmed that one-stage bilateral TKA increased the amount of blood transfusion, but could save hospital charges, and reduce the length of hospital stay. Thus, one-stage TKA is a safe effective method to treat bilateral knee arthritis, and deserves application. © 2015, Journal of Clinical Rehabilitative Tissue Engineering Research. All rights reserved.
    Article · Feb 2015 · Internal Medicine Journal
    • "A recent meta-analysis by Yang et al. [9] showed the use of TXA was not associated with increased perioperative complications. However, Yeager et al. [4] reported the patients who underwent bilateral TKA were at a higher risk of developing DVT or even PE. However, we did not see a significant increase in DVT in our study. "
    [Show abstract] [Hide abstract] ABSTRACT: IntroductionFew literatures have studied the blood management in patients treated with staged bilateral primary total knee arthroplasty (TKA) in a single hospitalization period. Therefore, this study aims to evaluate the effectiveness and safety of the newly introduced multimodal blood management (MBM) in these patients.Materials and methodsWe retrospectively compared the perioperative parameters in 70 cases undergoing staged bilateral primary TKA in a single hospitalization period from 2012¿2013 in a single center with two different groups of patients, allocating cases to the group with the newly introduced MBM (Group A, n =33) and controls to the group without the newly introduced MBM (Group B, n =37). The newly introduced MBM protocols include preoperative hemoglobin (Hb) evaluation, high protein diet, tourniquet release after skin closure, preoperative oral iron treatment and femoral canal obturation, and one dose of tranexamic acid (TXA) IV with another one if necessary. While in the control group, only routine blood-saving techniques were used.ResultsGroup A had a transfusion rate of 9% (3/33), whereas 32.4% of patients (12/37) in Group B received allogenic blood transfusion. Significant benefits were also found in Group A in terms of postoperative Hb and hematocrit (Hct), reduction of postoperative pain, swelling, postoperative pain, length of stays, and hospital costs. No deep vein thrombosis (DVT) events were found in all these patients.Conclusions The newly introduced MBM in staged bilateral TKA in a single hospitalization period can reduce blood loss effectively as well as pain and knee joint swelling instead of leading to increased complications and result in significant cost savings.
    Full-text · Article · Nov 2014
  • [Show abstract] [Hide abstract] ABSTRACT: Background Venous thromboembolism (VTE) remains a cause of significant morbidity and mortality following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Prophylaxis significantly reduces the rate of VTE following these procedures. Previous studies report sub-optimal uptake of guideline recommended thromboprophylaxis.AimsTo describe VTE prophylaxis prescribing practices in a major hospital for joint replacement surgery. To determine the proportion of patients receiving guideline recommended thromboprophylaxis. To define the incidence of in-hospital VTE following THA and TKA.MethodsA retrospective chart review of 402 consecutive patients undergoing THA or TKA from June to October 2013. Patient characteristics, operative and anaesthetic factors, details of thromboprophylaxis and the incidence of in-hospital VTE are reported. Comparison is made with recent guidelines.Results402 patients underwent THA (n=202) or TKA (n=200). 99% of patients received mechanical prophylaxis. 100% of patients received chemoprophylaxis in hospital. Enoxaparin was most commonly prescribed followed by aspirin. Patients undergoing TKA were more likely to receive an anticoagulant (89.9% vs 47.8% for THA, p <0.05). 74.5% received chemoprophylaxis on discharge (mean duration 22.1 days). The incidence of in-hospital VTE was 4.7%.Conclusions The proportion of study patients receiving thromboprophylaxis compares favourably with prior research. The overall incidence of VTE is higher than that demonstrated in major orthopaedic trials. Inadequate duration of chemoprophylaxis remains a potential area of improvement. Extended prophylaxis should be prescribed as per current guidelines. Comparison between efficacy and safety of various agents is the subject of future research.
    Article · Dec 2014
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