Venous Thromboembolism Following Arthroscopic Knee Surgery: A Current Concepts Review of Incidence, Prophylaxis, and Preoperative Risk Assessment

Abstract

The purpose of this review was to compile existing knowledge regarding venous thromboembolism (VTE) after arthroscopic knee surgery (AKS). We reviewed the reported incidence, published prophylaxis guidelines, randomized controlled trials (RCT) of prophylaxis, and current prophylaxis practice patterns. In this context we then considered the most appropriate VTE risk assessment model for patients undergoing knee arthroscopy. The existing body of literature regarding VTE and AKS reports a wide range of incidence, often utilizing primary outcome measures with unclear clinical significance: asymptomatic and distal deep vein thrombosis (DVT). Published prophylaxis guidelines provide limited practical guidance and it is unclear how to translate the results of RCTs to clinical practice, as many of the VTE prevented by routine prophylaxis are asymptomatic or distal DVT. Literature regarding actual implementation of pharmacologic prophylaxis following AKS suggests that no consensus exists. Patients undergoing knee arthroscopy would be best managed with the individual model of VTE risk assessment rather than the group model that is applied to hip and knee arthroplasty patients.