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Holler JT, Halvorson RT, Salesky M, Ma CB, Feeley BT, Leavitt AD, Lansdown DA, Zhang AL. Incidence of Venous Thromboembolism After Hip Arthroscopy Is Low With or Without Prophylaxis but Risk Factors Include Oral Contraceptive Use, Obesity, and Malignancy. Arthroscopy 2023; 39:981-987.e1. [PMID: 36334853 DOI: 10.1016/j.arthro.2022.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 09/28/2022] [Accepted: 10/20/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine the incidence of and risk factors for symptomatic venous thromboembolism (VTE) after hip arthroscopy (HA) and thromboprophylaxis prescription utilization for this procedure. METHODS The PearlDiver Mariner database was queried using Current Procedural Terminology codes to identify adult patients (aged ≥ 18 years) who underwent HA between 2010 and 2020. Patient demographic information, including age, oral contraceptive use, and medical comorbidities, as well as perioperative thromboprophylaxis utilization, was recorded using International Classification of Diseases codes and National Drug Codes. The incidence of postoperative VTE within 90 days was determined. Multivariate logistic regression was used to identify predictors of perioperative thromboprophylaxis utilization and risk factors for VTE. RESULTS The queried records identified 60,181 patients who met the inclusion criteria. Of these patients, 367 (0.6%) experienced VTE, including deep venous thrombosis (0.5%) and/or pulmonary embolism (0.2%). Approximately 2.1% of patients used thromboprophylaxis, including aspirin (1.1%), low-molecular-weight heparin (0.9%), and oral factor Xa inhibitors (0.1%). Oral contraceptive pill use (adjusted odds ratio [aOR], 2.16; 95% confidence interval [CI], 1.34-3.46), obesity (aOR, 1.37; 95% CI, 1.05-1.79), and a history of malignancy (aOR, 1.69; 95% CI, 1.12-2.54) were associated with increased odds of experiencing VTE. Perioperative thromboprophylaxis (aOR, 0.52; 95% CI, 0.19-1.39) was not significantly associated with decreased odds of experiencing VTE. However, obesity (aOR, 1.17; 95% CI, 1.00-1.38) and hypertension (aOR, 1.17; 95% CI, 1.02-1.36) were associated with increased odds of thromboprophylaxis prescription utilization. CONCLUSIONS Although the overall risk of symptomatic VTE after HA remains low, oral contraceptive use, obesity, and a history of malignancy are associated with increased odds of thromboembolic events within 90 days. Routine thromboprophylaxis after HA may not be indicated in all patients but can be considered based on patient-specific risk factors. LEVEL OF EVIDENCE Level III, retrospective prognostic comparative trial.
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Affiliation(s)
- Jordan T Holler
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Ryan T Halvorson
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Madeleine Salesky
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Andrew D Leavitt
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, California, U.S.A
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A..
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Cohen D, Ayeni OR. Editorial Commentary: A Patient-Specific Approach to Preventing Venous Thromboembolism After Hip Arthroscopy Is Essential. Arthroscopy 2023; 39:988-989. [PMID: 36872037 DOI: 10.1016/j.arthro.2022.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 03/07/2023]
Abstract
The incidence of hip arthroscopy (HA) has seen a dramatic rise over the past decade, with a bimodal distribution of patient age with peaks at both 18 and 42 years of age. Thus, it is essential to reduce complications, including venous thromboembolism (VTE), given reported incidences as high as 7%. Fortunately, more recent research, perhaps reflecting an evolution resulting in lower HA surgical traction times, has shown a VTE incidence of 0.6%. Perhaps because of such a low rate, recent research has also shown that generally, thromboprophylaxis does not significantly decrease the odds of VTE. The strongest predictors of VTE after HA are oral contraceptive use, prior malignancy, and obesity. Rehabilitation is also an important factor as some patients are ambulatory on postoperative day 1, reducing the VTE risk, whereas others require a few weeks of protected weight bearing, increasing their risk. A patient-specific approach to VTE prevention after HA, rather than a one-size-fits-all approach, is essential.
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Abstract
STUDY DESIGN Review. OBJECTIVE Venothromboembolic (VTE) complications, composed of deep vein thrombosis and pulmonary embolism are commonly observed in the perioperative setting. There are approximately 500 000 postoperative VTE cases annually in the United States and orthopedic procedures contribute significantly to this incidence. Data on the use of VTE prophylaxis in elective spinal surgery is sparse. This review aims to provide an updated consensus within the literature defining the risk factors, diagnosis, and the safety profile of routine use of pharmacological prophylaxis for VTE in elective spine surgery patients. METHODS A comprehensive review of the literature and compilation of findings relating to current identified risk factors for VTE, diagnostic methods, and prophylactic intervention and safety in elective spine surgery. RESULTS VTE prophylaxis use is still widely contested in elective spine surgery patients. The outlined benefits of mechanical prophylaxis compared with chemical prophylaxis varies among practitioners. CONCLUSION The benefits of any form of VTE prophylaxis continues to remain a controversial topic in the elective spine surgery setting. A specific set of guidelines for implementing prophylaxis is yet to be determined. As more risk factors for thromboembolic events are identified, the complexity surrounding intervention selection increases. The benefits of prophylaxis must also continue to be balanced against the increased risk of bleeding events and neurologic injury.
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Affiliation(s)
- Samantha Solaru
- University of Southern California, Los Angeles, CA, USA,Samantha Solaru, Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90033, USA.
| | - Ram K. Alluri
- Keck School of Medicine of the University of Southern California, Orthopaedic Surgery, CA, USA
| | | | - Raymond J. Hah
- University of Southern California Keck School of Medicine, Orthopaedic Surgery, CA, USA
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Fukushima K, Saito H, Koyama T, Ohashi Y, Uchiyama K, Takahira N, Takaso M. Incidences of deep vein thrombosis and major bleeding under the administration of fondaparinux for thromboprophylaxis after periacetabular osteotomy: a retrospective observational study. J Hip Preserv Surg 2021; 8:293-297. [PMID: 35414948 PMCID: PMC8994105 DOI: 10.1093/jhps/hnab066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/12/2021] [Accepted: 07/23/2021] [Indexed: 11/14/2022] Open
Abstract
Periacetabular osteotomy (PAO) is an effective joint-preserving procedure for patients with developmental dysplasia of the hip. Although deep vein thrombosis (DVT) is considered a serious complication of orthopaedic surgery, there is no consensus regarding a thromboprophylaxis strategy after PAO. We have routinely administered fondaparinux for DVT prophylaxis in adult patients undergoing PAO. The aim of this study was to investigate the incidences of DVT and major bleeding under the administration of fondaparinux for thromboprophylaxis after PAO. A total of 95 patients (100 hips) who underwent PAO with post-operative administration of fondaparinux for thromboprophylaxis were retrospectively enrolled. The incidences of DVT on ultrasound, major bleeding, and administration cessation were evaluated. Asymptomatic DVT occurred in one patient, major bleeding occurred in 14 hips and the administration of fondaparinux was stopped in 17 hips. Given the observed incidence of major bleeding, safer DVT prophylaxis modalities should be considered during PAO.
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Affiliation(s)
- Kensuke Fukushima
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Japan
| | - Hiroki Saito
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Japan
| | - Tomohisa Koyama
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Japan
| | - Yoshihisa Ohashi
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Japan
| | - Katsufumi Uchiyama
- Department of Patient Safety and Healthcare Administration, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara 252-0374, Japan
| | - Naonobu Takahira
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0329, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Japan
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Liao H, Wang Y. Application of Inferior Vena Cava Nanofilter Combined with Thrombolytic Catheter for Intravenous Thrombolysis in Deep Vein Thrombosis of Lower Extremities. J BIOMATER TISS ENG 2021. [DOI: 10.1166/jbt.2021.2721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Deep vein thrombosis (DVT) of the lower extremities has a high incidence and is insidiously fatal. Detachment of the thrombus can quickly cause death. Early detection and timely treatment are key to the treatment of DVT. This study is the first to report the clinical value of an inferior
vena cava nanofilter combined with thrombolytic catheter for intravenous thrombolysis in DVT. The study found that the inferior vena cava nanofilter combined with the thrombolytic catheter has a significant effect on the treatment of DVT, which greatly reduces the circumference difference
of the upper and lower legs, reduces the levels of fibrinogen, high-sensitivity C-reactive protein, and D-dimer, reduces the occurrence of complications, and is safe and worthwhile promotion.
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Affiliation(s)
- Hongwei Liao
- Department of Cardiovascular Surgery, Tangshan People’s Hospital, Tangshan 063000, Hebei, PR China
| | - Yi Wang
- Department of Clinical Laboratory, Tangshan People’s Hospital, Tangshan 063000, Hebei, PR China
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Verhoogt WAM, Pietrzak JRT, Ayeni OR, Cakic JN. Post-operative oral chemoprophylaxis in patients undergoing hip arthroscopy mitigates VTE risk with a low side-effect profile. J Hip Preserv Surg 2020; 7:524-532. [PMID: 33948208 PMCID: PMC8081424 DOI: 10.1093/jhps/hnaa063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/21/2020] [Accepted: 11/17/2020] [Indexed: 12/13/2022] Open
Abstract
Hip arthroscopy (HA) has increased exponentially over the last decade. A recent systematic review found that the risk of venous thromboembolism (VTE) is 2%. This was higher than previous reports which may have underestimated the true incidence of VTE in HA. Thus, protocols to mediate VTE may be more necessary than previously thought. The aim of this article is to present a VTE prevention protocol and evaluate its subsequent efficacy. This is a prospective study of 880 consecutive HA cases. All patients were treated according to a predetermined VTE protocol which classified patients as high (≥1 risk factors) or low (no risk factors) risk for post-operative VTE. In high-risk patients, the protocol followed that of low-risk patients but additionally included rivaroxaban for 2 weeks post-operatively. The incidence of VTE was recorded and analysed in this study. A total of 880 HA cases at an average age of 35.4 years were evaluated, with 76.6% (n = 674) undergoing labral repair and concomitant cam and/or pincer resection, 17.2% (n = 151) of cases for isolated labral tear repaired, and 6.1% (n = 55) classified as other. The overall incidence of VTE was 0.45%. The incidence of VTE was 1.2% and 0.16% in high- and low-risk groups, respectively. Oral VTE prophylaxis was not associated with post-operative complications. This study demonstrated a lower rate of VTE in both risk groups. It highlights the value of a predetermined risk-adjusted protocol to VTE prophylaxis. Rivaroxaban prophylaxis is safe and efficacious in HA with a low associated morbidity.
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Affiliation(s)
- Wesley A M Verhoogt
- Department of Orthopaedic Surgery, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Parktown, Johannesburg, 2193, South Africa
| | - Jurek R T Pietrzak
- Department of Orthopaedic Surgery, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Parktown, Johannesburg, 2193, South Africa
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster Children's Hospital,1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Josip N Cakic
- Department of Orthopaedic Surgery, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Parktown, Johannesburg, 2193, South Africa
- Centre for Sports Medicine and Orthopedics, Fourways Life Hospital, Cedar Ave West &, Cedar Rd, Fourways, Johannesburg, 2055, South Africa
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Fan W, Qiao T, You Y, Zhang J, Gao J. Perioperative prevalence of deep vein thrombosis in patients with percutaneous kyphoplasty: A retrospective study with routine ultrasonography. Medicine (Baltimore) 2020; 99:e19402. [PMID: 32150087 PMCID: PMC7478572 DOI: 10.1097/md.0000000000019402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In recent years, deep venous thrombosis (DVT) after spine surgery has received extensive attention, but perioperative prevalence of DVT in patients undergoing percutaneous kyphoplasty (PKP) is lacking.To assess the perioperative prevalence of deep vein thrombosis (DVT) in patients undergoing PKP with routinely applied ultrasonography.We reviewed 1113 consecutive patients undergoing PKP from January 2014 to August 2017. The surgical procedure was bilateral PKP. All patients were routinely examined with ultrasonography when admitted to the hospital and on the first post-operative day. Clinical signs of DVT were checked and recorded before examination.Forty (3.6%) out of 1113 patients were diagnosed with DVT by ultrasonography. Of the 40 detected cases of DVT, only six (0.54%) patients presented with clinical signs of DVT, demonstrating that there were 34 (3.05%) asymptomatic cases. No patient presenting with clinically suspected pulmonary embolism (PE) was observed. Gender, body mass index (BMI), operative time, hypertension, diabetes, heart disease, and lower limb fracture were not significant risk factors for DVT (P > .05). In contrast, patient age, oncologic conditions, DVT history, and paraplegia appeared to be significant risk factors for DVT (P < .01). There was no significant difference in the incidence of DVT found between the three PKP surgical levels (P > .05).The total incidence of perioperative DVT diagnosed with ultrasonography in patients undergoing PKP was 3.6%, of which only 0.54% was symptomatic cases. It is necessary to assess DVT using ultrasonography during the perioperative procedure of PKP, especially for high-risk patients.Level of evidence: Level IV.
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Affiliation(s)
- Wencan Fan
- Department of Orthopaedic Surgery, Daqing Oilfield General Hospital, Heilongjiang 163001
| | - Tianzhu Qiao
- Department of Orthopaedic Surgery, Daqing Oilfield General Hospital, Heilongjiang 163001
| | - Yongqing You
- Department of Nephrology, Affiliated Hospital of Nanjing Medical University, North District of Suzhou Municipal Hospital, Suzhou
| | - Jun Zhang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, Shizi Road, Suzhou 215006
| | - Jijian Gao
- Department of Orthopaedic Surgery, Shengzhou People's Hospital, The First Affiliated Hospital of Zhejiang University Shengzhou Branch, Zhejiang, China
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Guan Z. Changes in expression of serum chemokine CXCL13 and IL-6 after hip replacement, and the relationship with lower limb vein thrombus. Exp Ther Med 2020; 19:2113-2118. [PMID: 32104273 DOI: 10.3892/etm.2019.8365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/02/2019] [Indexed: 01/02/2023] Open
Abstract
Changes in the expression of serum chemokine CXC ligand 13 (CXCL13) and interleukin-6 (IL-6), and the relationship with lower limb vein thrombus were explored. A total of 128 patients undergoing hip replacement in The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine from May 2017 to June 2019 were selected, and the patients suffering from lower limb vein thrombus were enrolled as group A and other patients not suffering from it were enrolled as group B. Enzyme-linked immuno-sorbent assay was employed to determine the levels of serum chemokine CXCL13 and IL-6, and receiver operating characteristic curves of serum chemokine CXCL13 and IL-6 levels in diagnosing restenosis after surgery were drawn. Pearson's correlation coefficient was adopted to analyze the correlation between serum chemokine CXCL13 and IL-6, and the logistic regression analysis to analyze the risk factors affecting hip replacement in patients. The levels of serum CXCL13 and IL-6 in group A were significantly higher than those in group B (both P<0.001). The specificity and sensitivity of serum CXCL13 level in diagnosis of lower limb vein thrombus after hip replacement were 61.76 and 80.00%, respectively, and those of serum IL-6 level in diagnosis were 70.59 and 66.67%, respectively. Serum CXCL13 level was positively correlated with serum IL-6 level (P<0.001), and age, body mass index (BMI), CXCL13 level and IL-6 level of the patients were independent risk factors affecting the efficacy of hip replacement. Serum CXCL13 level and serum IL-6 level can be used as biological indexes for prediction of early lower limb vein thrombus after hip replacement, and logistic regression analysis revealed that the age of the patients, BMI, diabetes history, hyperlipidemia history, hypertension history, CXCL13 level and IL-6 level are independent risk factors affecting the efficacy of hip replacement.
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Affiliation(s)
- Zhiyu Guan
- Department of Tramotology and Orthopedics, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou 550001, P.R. China
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Zhang Y, Shao Y, Liu H, He F, Bou E, Yang H, Pi B. Influence of Chronic Kidney Disease on Patients Undergoing Elective Hip and Knee Orthopedic Surgery: A Systematic Review and Meta-Analysis. J INVEST SURG 2019; 34:346-356. [PMID: 31500490 DOI: 10.1080/08941939.2019.1631412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Yijian Zhang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- Orthopedic Institute, Soochow University, Suzhou, People’s Republic of China
| | - Yijie Shao
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- Orthopedic Institute, Soochow University, Suzhou, People’s Republic of China
| | - Hao Liu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- Orthopedic Institute, Soochow University, Suzhou, People’s Republic of China
| | - Fan He
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- Orthopedic Institute, Soochow University, Suzhou, People’s Republic of China
| | - Emily Bou
- Biochemistry Department, University of Waterloo, Waterloo, Canada
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- Orthopedic Institute, Soochow University, Suzhou, People’s Republic of China
| | - Bin Pi
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- Orthopedic Institute, Soochow University, Suzhou, People’s Republic of China
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Incidence and Risk Factors for Venous Thromboembolism Following Hip Arthroscopy: A Population-Based Study. Arthroscopy 2019; 35:2380-2384.e1. [PMID: 31395174 DOI: 10.1016/j.arthro.2019.03.054] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/20/2019] [Accepted: 03/24/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the incidence of symptomatic venous thromboembolism (VTE) after hip arthroscopy (HA) using a large national database while considering several patient demographic factors. METHODS Patients ≥20 years old who underwent HA between 2007 and 2017 were identified within the Humana administrative claims database using relevant Current Procedural Terminology and International Classification of Diseases Ninth and Tenth Revision codes. Basic demographics, including age, gender, obesity (body mass index ≥ 30 kg/m2), oral contraceptive use, smoking history, diabetes, and chronic obstructive pulmonary disease (CLD) were recorded. Postoperative incidence of deep vein thrombosis, pulmonary embolism, and VTE was identified at 30 and 90 days postoperatively. Multivariate logistic regression analysis was performed to identify independent risk factors for VTE after HA, with statistical significance set at P < .05. RESULTS Overall, 9,477 patients underwent HA procedures over the study period, of whom 5,085 (53.7%) were female. The overall incidence of VTE in all patients was 0.77% (n = 73) and 1.14% (n = 108) at 30 and 90 days, respectively. Multivariate analysis identified age ≥ 45 (odds ratio [OR] = 1.82; 95% confidence interval [CI], 1.36-2.49; P = .0001), obesity (OR = 1.54; 95% CI, 1.27-1.86; P < .0001), smoking (OR = 1.26; 95% CI, 1.04-1.53; P = .0177), diabetes (OR = 1.59; 95% CI, 1.32-1.92; P < .0001), and CLD (OR = 2.10; 95% CI, 1.63-2.68; P < .0001) as independent risk factors for higher incidence of VTE after HA. However, neither gender nor oral contraceptive use were risk factors for VTE after HA. CONCLUSIONS For patients undergoing HA, the incidence of symptomatic postoperative VTE is low. This study identified age ≥45, obesity, tobacco use, diabetes, and CLD as independent risk factors for VTE after HA. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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12
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Parsa A, Nazal MR, Stelzer JW, Sieff CA, Martin SD. A Successful Collaborative Approach to the Perioperative Management After Hip Arthroscopy of a Patient with Heterozygous Prothrombin G20210A Mutation: A Case Report. JBJS Case Connect 2019; 9:e0376. [PMID: 31085938 DOI: 10.2106/jbjs.cc.18.00376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report on a patient with heterozygous prothrombin G20210A mutation (PTM) and a history of venous thromboembolism (VTE) after knee arthroscopy, who was undergoing hip arthroscopy. This common mutation has an overall prevalence of 2.0% and results in a 280% to 420% likelihood of thrombosis compared to patients without the mutation. CONCLUSIONS Hip arthroscopy is associated with a low risk of VTE with currently no guidelines for thromboprophylaxis. Patients should be managed in relation to their risk factors utilizing a collaborative, individualized approach. Treatment with short-term low-molecular-weight heparin resulted in no thromboembolism at 18-month follow-up for this patient with PTM.
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Affiliation(s)
- Ali Parsa
- Department of Orthopaedic Surgery, Sports Medicine, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts.,Orthopedic Research Center, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Mark R Nazal
- Department of Orthopaedic Surgery, Sports Medicine, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts
| | - John W Stelzer
- Department of Orthopaedic Surgery, Sports Medicine, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts
| | - Colin A Sieff
- Division of Hematology/Oncology, Dana-Farber and Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Scott D Martin
- Department of Orthopaedic Surgery, Sports Medicine, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts
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Schüttler KF, Schramm R, El-Zayat BF, Schofer MD, Efe T, Heyse TJ. The effect of surgeon's learning curve: complications and outcome after hip arthroscopy. Arch Orthop Trauma Surg 2018; 138:1415-1421. [PMID: 29802454 DOI: 10.1007/s00402-018-2960-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The aim of the present study was to determine the incidence and type of complications during and after hip arthroscopy as well as the effect of the surgeon's learning curve on the occurrence of complications. We expect that the currently reported prevalence especially of minor complications is likely to be underreported in most retrospective series based on chart analysis. MATERIALS AND METHODS The study included all consecutive patients who underwent hip arthroscopy between 2006 and 2014 at a minimum follow-up of 6 weeks starting with the first patient undergoing hip arthroscopy at the institution. Patient outcome was evaluated using the WOMAC score, VAS for pain, SF-36 questionnaire and the hip-outcome score. Additionally, intra- and postoperative complications were recorded via a questionnaire and additional review of patient files. RESULTS We identified 529 patients who underwent hip arthroscopy between 2006 and 2014. Complete data could be gathered from 485 patients (91.7%). Major complications occurred in three patients (0.6%; fractures of the femoral neck requiring surgical treatment in one case). Minor complications that did not require further intervention were self-limiting postoperative temporary neurapraxia, hematoma, self-limiting dyspareunia, deep vein thrombosis and impaired wound healing, with hematoma and temporary paresthesia due to traction neurapraxia being the most common ones (22.5 and 16.4% respectively). The overall re-operation rate was 15.7% with conversion to total hip arthroplasty being the most common (11.9%). CONCLUSIONS The overall major complication rate was low and thus hip arthroscopy can be rated as a safe procedure. But minor complications such as hematoma and temporary paresthesia due to traction neurapraxia are common and currently underreported. Surgeons' learning curves show a reduction of major complications once 60 procedures per surgeon per year is surpassed.
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Affiliation(s)
- Karl F Schüttler
- Center of Orthopedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| | - Rose Schramm
- Center of Orthopedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Bilal F El-Zayat
- Center of Orthopedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | | | - Turgay Efe
- Center of Orthopedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany.,Orthopaedicum Lich, Lich, Germany
| | - Thomas J Heyse
- Center of Orthopedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
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Bolia IK, Fagotti L, McNamara S, Dornan G, Briggs KK, Philippon MJ. A systematic review-meta-analysis of venous thromboembolic events following primary hip arthroscopy for FAI: clinical and epidemiologic considerations. J Hip Preserv Surg 2018; 5:190-201. [PMID: 30393545 PMCID: PMC6206692 DOI: 10.1093/jhps/hny029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/08/2018] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to report the proportion of venous thromboembolic events (VTE) in patients undergoing primary hip arthroscopy for femoroacetabular impingement (FAI) and present a critical overview of the literature to aid in better result interpretation. MedLine, Scopus and Web of Science databases were searched from January 2000 to March 2017. Four thousand-five-hundred and seventy-seven hip cases were included in the meta-analysis of 38 studies. The mean age of patients was 36 ± 1.8 years and the mean follow-up time was 20.6 months. The meta-analysed rate of deep vein thrombosis (DVT) in patients undergoing primary hip arthroscopy for FAI syndrome was 1.18%; 95%CI [0.8–1.74%]; The meta-analysed rate of pulmonary embolism (PE) in patients undergoing primary hip arthroscopy for FAI syndrome was 0.59%; 95%CI [0.38–0.92%]. Quality assessment was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria the Quality in Prognostic Studies (QUIPS) tool. Sensitivity analysis was conducted to assess for publication bias and its influence on the results. The corrected for publication bias proportion of DVT was 2.02%; 95%CI [1.36–2.99%]. The DVT rate was double following the correction of bias while additional types of bias were detected. Attention must be paid when considering the outcomes of observational studies to make clinical decisions. Insufficient evidence exists to support whether anti-VTE chemoprophylaxis should be administered to patients undergoing primary hip arthroscopy for FAI. Due to the life-threatening character of this complication, the results should serve as starting point to design clinical trials and establish guidelines. Until then, the application of preventive measures against VTE should be decided on a case-by-case basis.
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Affiliation(s)
- Ioanna K Bolia
- Department of Hip Research, Steadman Philippon Research Institute, Vail, CO, USA
| | - Lorenzo Fagotti
- Department of Hip Research, Steadman Philippon Research Institute, Vail, CO, USA
| | - Shannen McNamara
- Department of Hip Research, Steadman Philippon Research Institute, Vail, CO, USA
| | - Grant Dornan
- Department of Hip Research, Steadman Philippon Research Institute, Vail, CO, USA
| | - Karen K Briggs
- Department of Hip Research, Steadman Philippon Research Institute, Vail, CO, USA
| | - Marc J Philippon
- Department of Hip Research, Steadman Philippon Research Institute, Vail, CO, USA.,Department of Hip Research, The Steadman Clinic, 181 W. Meadow Dr., Vail, CO, USA
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Aali Rezaie A, Azboy I, Parvizi J. Venous thromboembolism prophylaxis after hip preservation surgery: a review and presentation of institutional experience. J Hip Preserv Surg 2018; 5:181-189. [PMID: 30393544 PMCID: PMC6206688 DOI: 10.1093/jhps/hny016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/26/2018] [Indexed: 11/24/2022] Open
Abstract
Venous thromboembolism (VTE) is a serious complication after major orthopedic procedures. The best options for prevention of the VTE are still debated. The most popular evidence-based guidelines for prevention and treatment of VTE in orthopedic surgery addressed the total hip or knee arthroplasty and hip fractures as the major orthopedic surgeries. Majority of studies have evaluated the different modalities of the VTE prophylaxis in patients undergiong hip or knee arthroplasty. Hip preservation surgeries (HPS) including mini-open femoroacetabular osteoplasty, surgical dislocation of the hip, arthroscopic procedures, and periacetabular osteotomy (PAO) are gained popularity in recent two decades. The majority of these patients are young, healthy and active and may not be considered at high risk for VTE. The frequency of VTE in patients undergoing PAO seems to be low between 0 and 5%. There is a paucity of data regarding rates of VTE in young healthy patients undergoing HPS as well as the optimal prevention methods for VTE. Hence current VTE prevention guidelines do not cover HPS adequately. We aimed to review the available literature regarding VTE events and VTE prophylaxis options after HPS. We discussed the available and potential options for prophylaxis of VTE events in these procedures along with our experience in a large cohort of hip preservation surgery.
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Affiliation(s)
- Arash Aali Rezaie
- The Rothman Institute, Thomas Jefferson University, 125 S 9th St. Ste 1000, Philadelphia, PA, USA
| | - Ibrahim Azboy
- İstanbul Medipol University, Department of Orthopaedic and Traumatology, Koşuyolu Medipol Hospital, İstanbul, Turkey
- Istanbul Medipol University, Department of Orthopaedics and Traumatology, Beykoz, Istanbul, Turkey
| | - Javad Parvizi
- The Rothman Institute, Thomas Jefferson University, 125 S 9th St. Ste 1000, Philadelphia, PA, USA
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Nakano F, Matsubara T, Ishigaki T, Hatazaki S, Mouri G, Nakatsuka Y, Suzuki H. Incidence and risk factor of deep venous thrombosis in patients undergoing craniotomy for brain tumors: A Japanese single-center, retrospective study. Thromb Res 2018; 165:95-100. [DOI: 10.1016/j.thromres.2018.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/20/2018] [Accepted: 03/24/2018] [Indexed: 02/06/2023]
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Hoskote SS, Yadav H, Jagtap P, Wigle DA, Daniels CE. Chylothorax as a Risk Factor for Thrombosis in Adults: A Proof-of-Concept Study. Ann Thorac Surg 2018; 105:1065-1070. [PMID: 29452999 DOI: 10.1016/j.athoracsur.2017.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 09/18/2017] [Accepted: 11/04/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Postoperative chylothorax in children is associated with an increased risk of vascular thrombosis, hypothesized to be from loss of antithrombin into chylous fluid resulting in a hypercoagulable state. In adults, an increased thrombotic risk with chylothorax has not been described. Adults undergoing Ivor-Lewis esophagogastrectomy have two strong thrombotic risk factors-active malignancy and postoperative state-allowing for relative homogeneity in baseline thrombotic risk; therefore, we studied the association of chylothorax with thrombosis in this population. METHODS We performed a single-center retrospective cohort study at a tertiary care academic center. Patients included adults undergoing Ivor-Lewis esophagogastrectomy between January 1, 2006, and December 31, 2012. We collected demographics, pleural fluid characteristics, and relevant imaging within 30 days after the operation. Using nominal logistic regression, we studied the effects of chylothorax, age, sex, body mass index, American Society of Anesthesiologists Physical Status Classification, operative duration, and hospital length of stay on the incidence of postoperative thrombosis. RESULTS We identified 608 patients who underwent Ivor-Lewis esophagogastrectomy. Of these, 524 (86.2%) had no pleural fluid analysis, 48 (7.9%) had nonchylous effusions, and 36 (5.9%) had chylothoraces, with incident acute vascular thrombosis within 30 days postoperatively occurring in 22 of 524 (4.2%), 2 of 48 (4.2%), and 8 of 36 (22.2%), respectively (p = 0.001). In multivariate analyses, after adjusting for the above factors, chylothorax was associated with significantly higher odds of any vascular thrombosis (odds ratio, 5.46; p = 0.0013) and deep venous thrombosis/pulmonary embolism (odds ratio, 6.76; p = 0.0016). CONCLUSIONS Chylothorax is associated with a significantly higher incidence of vascular thrombosis in adults undergoing Ivor-Lewis esophagogastrectomy. Vascular thrombosis was associated with a significantly higher 90-day mortality rate.
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Affiliation(s)
- Sumedh S Hoskote
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Hemang Yadav
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Prashant Jagtap
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Dennis A Wigle
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Craig E Daniels
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
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Haldane CE, Ekhtiari S, de Sa D, Simunovic N, Safran M, Randelli F, Duong A, Farrokhyar F, Ayeni OR. Venous Thromboembolism Events After Hip Arthroscopy: A Systematic Review. Arthroscopy 2018; 34:321-330.e1. [PMID: 28969946 DOI: 10.1016/j.arthro.2017.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 07/05/2017] [Accepted: 07/05/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this systematic literature review focused on hip arthroscopy was to (1) report the venous thromboembolism (VTE) event incidence in patients who receive VTE prophylaxis and those who do not, (2) report how VTE prophylaxis is currently being administered, and (3) report operative and patient-related risk factors for VTE identified in the literature. METHODS The electronic databases MEDLINE, Embase, and PubMed were searched from database inception to October 10, 2016, and screened in duplicate for relevant studies. Data were collected regarding VTE prophylaxis, traction use, surgical time, VTE incidence, patient and operative factors, and postoperative weight bearing and rehabilitation. Study quality was assessed in duplicate with the Methodological Index for Non-Randomized Studies criteria. RESULTS Outcome analyses included 14 studies that involved 2,850 patients (2,985 hips). The weighted mean follow-up period was 19 ± 8 months, ranging from 7 days to 103 months. The weighted mean age was 40.7 ± 7 years, ranging from 6 to 82 years, and 39.6% of patients were male patients. The overall weighted proportion of VTE events after hip arthroscopy found in 14 included studies was 2.0% (95% confidence interval, 0.01%-4.1%), with 25 VTE events. Several studies reported patient risk factors, which included increased age, increased body mass index, prolonged traction time, and use of oral contraceptives. CONCLUSIONS The use and efficacy of VTE prophylaxis are highly under-reported within hip arthroscopy. The low incidence of VTE events found in this review (2.0%) suggests that prophylaxis may not be necessary in low-risk patients undergoing hip arthroscopy; however, the true rate may be under-reported. Current literature suggests that prophylaxis is typically not prescribed. Early mobility and postoperative rehabilitation may also help to further mitigate the risk of VTE events, but use of these strategies needs further prospective evaluation. LEVEL OF EVIDENCE Level IV, systematic review of Level II through IV studies.
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Affiliation(s)
- Chloe E Haldane
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Seper Ekhtiari
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Department of Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Marc Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, U.S.A
| | - Filippo Randelli
- Dipartimento di Ortopedia e Traumatologia V, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, Milan, Italy
| | - Andrew Duong
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
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Ellenrieder M, Tischer T, Bader R, Kreuz PC, Mittelmeier W. Patient-specific factors influencing the traction forces in hip arthroscopy. Arch Orthop Trauma Surg 2017; 137:81-87. [PMID: 27695971 DOI: 10.1007/s00402-016-2572-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The application of traction in hip arthroscopy is associated with peri-operative complications. Within a therapeutic case series, patient-related factors correlating with high-traction forces during hip arthroscopy and occurring complications should be identified. MATERIALS AND METHODS In 30 male and 38 female patients (mean age: 44.5 years), intra-operative traction forces were monitored continuously using a specialised measurement device. A multivariate analysis was employed to identify patient-related factors influencing the traction force. Peri-operative complications (follow-up: 12 weeks) were evaluated by performing a single-case analysis. RESULTS The mean initial force prior to penetration of the capsule ("initial force") was 477 N (men: 517 N; women: 444 N), decreasing after capsulotomy by an average of 17 %. The male gender (p < 0.001), Kellgren and Lawrence radiographic stage (p = 0.037), low minimum joint-space width (p = 0.029) and high body height/weight (p = 0.003/0.037) correlated significantly with higher distraction forces. The patient age and type of anaesthesia (general versus spinal) were not relevant. Complications were observed in ten patients on the first post-operative day. In two of these patients a partial sensory deficit of the lateral cutaneous femoral nerve persisted after 12 weeks. All patients with complications required initial traction forces of >400 N. CONCLUSIONS The study revealed several patient-specific risk factors correlating with high-traction forces during hip arthroscopy. With view to potential complications, these patient groups require special attention during surgical treatment as well as in future studies.
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Affiliation(s)
- Martin Ellenrieder
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Strasse 142, 18057, Rostock, Germany.
| | - Thomas Tischer
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Strasse 142, 18057, Rostock, Germany
| | - Rainer Bader
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Strasse 142, 18057, Rostock, Germany
| | - Peter Cornelius Kreuz
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Strasse 142, 18057, Rostock, Germany
| | - Wolfram Mittelmeier
- Department of Orthopaedics, Rostock University Medical Center, Doberaner Strasse 142, 18057, Rostock, Germany
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