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Easwaran R, Khan M, Sancheti P, Shyam A, Bhandari M, Ranawat AS, Thakkar S, Parikh S, Musahl V, Joglekar S, J Deshmukh A, Plancher K, Verma N, McAllister D, Verdonk P, Lustig S, Chandrateya A, Smigleiski R, Solayar G, Chernchujit B, Yung P, Budhiparama N, Hoshino Y, White N, Parker D, Clatworthy M, Brown C, Manzary M, Rajan D, Narvekar A, Tapasvi S, Pardiwala D, Panigrahi R, Arumugam S, Kapoor V, Mody B, Maheshwari J, Dahiya V, Joseph C, Laddha M, Rajgopal A. Prophylaxis for preventing venous thromboembolism in knee arthroscopy and soft tissue reconstruction: consensus statements from an international panel of experts. Knee Surg Sports Traumatol Arthrosc 2022; 30:3634-3643. [PMID: 35435469 PMCID: PMC9013735 DOI: 10.1007/s00167-022-06973-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE There is a lack of consensus regarding need for Venous Thrombo Embolism (VTE) prophylaxis following arthroscopic knee surgery and open soft tissue knee reconstruction. Clear cut guidelines like ones for trauma surgery and arthroplasty do not exist and the published literature is limited to case reports with a few society guidelines. Given this lack of consensus, we conducted a modified Delphi questionnaire of international experts to provide recommendations on this topic. METHODS The consensus statements were generated using an anonymised 3 round modified Delphi questionnaire, sent to an international panel of 38 knee surgeons, with an 80% agreement being set as the limit for consensus. The responses were analysed using descriptive statistics with measures like mode, median and box plots. Feedback was provided to all panelists based on responses from the previous rounds to help generate the consensus. RESULTS Six consensus statements were generated after the three rounds of Delphi. Patient factors, prolonged surgery duration and family history of thrombogenic events emerged as the main points to be taken into consideration for prophylaxis. CONCLUSION It was established through this study, that there exists a select group of patients undergoing arthroscopic surgery that justify the usage of VTE prophylaxis. The expert responses to most of the questions in different scenarios favoured usage of VTE prophylaxis based on patient factors like advanced age, past history of VTE, smoking, oral contraceptive use etc. LEVEL OF EVIDENCE: Level V.
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Affiliation(s)
- Raju Easwaran
- Shree Meenakshi Orthopedics and Sports Medicine Clinic, B H 41 East, Shalimar Bagh, New Delhi, 110088, India.
- Department of Arthroscopy and Sports Injuries, Max Super-Speciality Hospital Shalimar Bagh, New Delhi, India.
| | - Moin Khan
- Sports Medicine and Shoulder Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - Parag Sancheti
- Sancheti Institute for Orthopaedics and Rehabilitation and PG College, Pune, India
| | - Ashok Shyam
- Sancheti Institute for Orthopedics and Rehabilitation, Pune, India
| | - Mohit Bhandari
- Chair, Department of Surgery, McMaster University, Hamilton, Canada
| | - Anil S Ranawat
- Knee Division of SMI, Hospital for Special Surgery, New York, USA
| | - Savyasachi Thakkar
- Johns Hopkins Orthopaedics, Hip and Knee Reconstruction Surgery, Columbia, USA
| | - Shital Parikh
- Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Volker Musahl
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Siddharth Joglekar
- Orthopedic Service, VA Central California Health Care System, Fresno, CA, USA
- UCSF Fresno Orthopedic Residency Program, Fresno, USA
| | | | - Kevin Plancher
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, NY, USA
- Weill Cornell Medical College, New York, USA
- Orthopaedic Foundation, Stamford, CT, USA
- Plancher Orthopaedics and Sports Medicine, New York, USA
| | - Nikhil Verma
- Division of Sports Medicine, Sports Medicine Fellowship, Rush University Medical Center, Midwest Orthopedics at Rush, Chicago, USA
| | - David McAllister
- Sports Medicine Service, Vice Chair of Academic Affairs, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
- UCLA Department of Athletics, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Peter Verdonk
- Orthopaedic Center Antwerp, Antwerp, Belgium
- Department of Orthopaedic Surgery, Antwerp University, Antwerp, Belgium
| | - Sebastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, Lyon, France
| | - Amit Chandrateya
- Princess of Wales Hospital Bridgend, Cwm Taf Morgannwg University Health Board, Bridgend, UK
| | - Robert Smigleiski
- Orthopaedics and Sports Medicine, Department at LIFE Institute, LIFE Institute Biological Treatment Centre, Warsaw, Poland
| | - Gandhi Solayar
- Orthopaedic Specialist Centre, Subang Jaya, Selangor, Malaysia
| | - Bancha Chernchujit
- Department of Orthopedics, Thammasat University Hospital, Khlong Nueng, Thailand
| | - Patrick Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong, China
| | - Nicolaas Budhiparama
- School of Vocational Studies and Department of Orthopaedics and Traumatology, School of Medicine, University of Airlangga, Jl. Mayjend. Prof. Dr. Moestopo, Jawa Timur, Indonesia
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Medistra Hospital, Jakarta, Indonesia
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, School of Medicine, Kobe University, Kobe, Japan
| | | | - David Parker
- Sydney Orthopaedic Research Institute, Chatswood, Australia
| | | | - Charlie Brown
- International Knee and Joint Centre, Abu Dhabi, United Arab Emirates
| | - Mojieb Manzary
- Orthopedic Services, Johns Hopkins Aramco Health Care Center, Dhahran, Saudi Arabia
- Department of Orthopedics, Johns Hopkins University School of Medicine, Dhahran, Saudi Arabia
| | - David Rajan
- Ortho One-Orthopaedic Speciality Centre, Coimbatore, India
| | - Abhay Narvekar
- P D Hinduja Hospitals Mumbai, Global Hospital Parel, Mumbai, India
| | | | - Dinshaw Pardiwala
- Arthroscopy Service, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - Ranjit Panigrahi
- PG Dept of Orthopaedics, Hitech Medical College and Hospital, Bhubaneswar, Odisha, India
- Kalinga Super Speciality Hospital, Bhubaneswar, Odisha, India
| | - S Arumugam
- Centre for Sports Science, Sri Ramachandra Institute of Higher Education and Research (Deemed University), Chennai, India
| | - Vikash Kapoor
- Medica Superspeciality Hospital, Medica Hospitals, Kolkata, India
| | - Bharat Mody
- Welcare Hospital, Atladra-Vadsar Ring Road, Atladra, Vadodara, Gujarat, India
| | - Jitender Maheshwari
- Knee and Shoulder Service, Department of Orthopaedics, Sitaram Bharatiya Hospital, New Delhi, India
| | - Vivek Dahiya
- Adult Reconstruction Lower Limb, Institute of Musculoskeletal Disorders and Orthopaedics, Medanta, Gurugram, India
| | - Clement Joseph
- Arthroscopy and Sports Medicine, Asian Joint Reconstruction Institute, SIMS, Chennai, India
| | | | - Ashok Rajgopal
- Institute of Musculoskeletal Diseases and Orthopaedics, Medanta Medicity, Gurugram, Haryana, India
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