Abstract
BackgroundWe sought to document the incidences of deep vein thrombosis (DVT) before and after total knee arthroplasty (TKA). In addition, we aimed to explor whether routine preoperative DVT evaluation was useful to establish DVT treatment strategies after TKA. Finally, we wanted to evaluate whether the incidences of DVT differed between patients undergoing unilateral and staged bilateral TKA within the same hospitalization period.MethodsThe retrospective study included 153 consecutive patients (253 knees) with osteoarthritis who underwent primary TKA. After surgery, mechanical compression devices (only) were used for DVT prophylaxis. DVT status before and after TKA was determined via 128-row, multidetector, computed tomography/indirect venography.ResultsOverall, the preoperative DVT incidence was 2.6% per patient and 1.6% per knee. All preoperative DVTs were distal in nature and asymptomatic. After TKA, newly developed thrombi were evident in various calf veins, without propagation of any pre-existing thrombi. Postoperatively, the overall incidences of DVT were 69.9% per patient and 58.5% per knee. The DVT incidences were 66% per patient and 69.8% per knee in the unilateral TKA group. In contrast, the incidences were 72% per patient and 55.5% per knee in the staged bilateral TKA group. There was one case of symptomatic distal (unilateral TKA; 0.65% per patient and 0.4% per knee) and proximal DVT (bilateral TKA; 0.65% per patient and 0.4% per knee), respectively.ConclusionsThe incidence of symptomatic DVT was low in Asian patients treated with mechanical compression devices alone, although substantial portion of patients had DVT after surgery. Routine preoperative DVT evaluation is probably not necessary; preoperative DVT was rare and of limited clinical relevance. Furthermore, staged bilateral TKA during a single period of hospitalization does not increase the incidence of DVT.
Highlights
We sought to document the incidences of deep vein thrombosis (DVT) before and after total knee arthroplasty (TKA)
Our principal findings were: 1) the incidence of preoperative DVT was low (2.6%) and of limited clinical significance; all affected patients developed postoperative DVT at different sites; 2) a considerable proportion of patients developed postoperative DVT, most was distal and asymptomatic; we found one example of symptomatic Pulmonary embolism (PE); and, 3) staged bilateral TKA during a single period of hospitalization does not increase the incidence of DVT
As a 128-row Multidetector computed tomography (MDCT) is more accurate than the devices used in earlier studies, we initially hypothesized that the preoperative incidence would be higher than reported previously [23, 24]
Summary
We sought to document the incidences of deep vein thrombosis (DVT) before and after total knee arthroplasty (TKA). Deep vein thrombosis (DVT) is a frequent and significant complication after total knee arthroplasty (TKA) [1, 2]. The incidence, diagnosis, prevention, and treatment of DVT remain controversial [1, 3,4,5,6,7,8,9]. Most recent studies have recorded lower incidences of DVT in Asian patients; routine pharmacological prophylaxis is not recommended [1, 2, 6]. Studies on the use of mechanical compression devices (alone) to prevent DVT have become more common [1, 2, 6, 15]. The use of such devices alone, without pharmacological treatment, would be less effective than the combination
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