DVT and Orthopedic Surgery
DVT can strike after any surgery. But according to the America Association of Orthopedic Surgeons (AAOS), those having surgery on their lower extremities are at particularly high risk. Because preventive prophylaxis is imperative, AAOS Guidelines state that hip or knee arthroplasty patients with a bleeding disorder or liver disease use mechanical compressive devices for preventing DVT. Guidelines established by the American College of Chest Physicians (ACCP) concur and recommend at least 10 days of prophylaxis following high-risk orthopedic surgery and 28-35 days following total hip arthroplasty or hip fracture surgery. ACCP Guidelines suggest pharmacologic agents and/or mechanical compressive devices for hip or knee arthroplasty patients who are not at elevated DVT risk beyond that of the surgery itself.
Patients undergoing major orthopedic surgery including hip and knee replacements are at particularly high risk for DVT.
Prevention of Venous Thromboembolism in Surgical Patients. Giancarlo Agnelli, MD
DVT is the most common cause for hospital readmission after hip replacement.
Seagroatt V, Tan HS, Goldacre M, et al. Elective total hip replacement: incidence, emergency readmission rate, and postoperative mortality. BMJ. 1991; 303: 1431–1435
DVT peaks on the fifth postoperative day, and the vulnerability to DVT appears to last for three months. This reflects the belief of most orthopedic surgeons that prophylactic therapy should continue beyond the acute care facility until the patient is spending the majority of his day ambulating.
Fitzgerald RH Jr., Orthopedics. 1996 Aug; 19 Suppl: 15-8
DVT prevention has been at the forefront of orthopedic care for lower extremity arthroplasty, which is at high risk for DVT. Risk of bleeding increases in total hip arthroplasty with low-molecular-weight heparin (LMWH) prophylaxis. A mobile compression device (MCD) that allows patients to move freely in hospital and at home may be safer.
Hardwick ME, Pulido PA, Colwell CW Jr. Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
Majority of DVTs develop 5-10 days following surgery.
Venous Thromboembolism Following Major Orthopedic Surgery: What is the Risk After Discharge? Juan I. Arcelus, MD, PhD, 1 James C. Kudrna, MD, PhD,2-4 and Joseph A. Caprini, MD, MS