AAOS Guidelines for the Prevention of Symptomatic Pulmonary Embolism After Total Hip and Total Knee Arthroplasty: Advantages and Disadvantages

Abstract

The American Academy of Orthopedic Surgeons has published a clinical guideline for the prevention of symptomatic pulmonary embolism in patients undergoing total hip and total knee arthroplasty. This guideline includes recommendations from a consensus process and a review and analysis of 42 publications since 1996. The end points for analysis were symptomatic and fatal pulmonary embolism rates, total death rates, and major bleeding complications. The guideline recommends preoperative risk stratification of all patients for “standard” and “high” risks of both pulmonary embolism and major bleeding complications. The use of regional anesthesia, mechanical prophylaxis, rapid mobilization, and patient education were consensus recommendations. The choice of a specific medication postoperatively by the surgeon should be based on an individual risk–benefit analysis of pulmonary embolism and major bleeding complications. The advantages of this guideline include a greater concern for bleeding and other local wound complications that could affect overall patient outcome, and the ability of the surgeon to treat each patient as an individual. The disadvantages of this guideline include placing hip and knee arthroplasty patients into a single group, the lower levels of evidence for the recommendations, and the relative lack of acceptance by other specialty groups and governmental agencies.