No difference in the incidence or location of deep venous thrombosis according to use of pharmacological prophylaxis following total knee arthroplasty

The necessity of suction drainage when intra-articular injection of tranexamic acid is used during primary total knee arthroplasty: a retrospective study

BACKGROUND

Suction drainages are commonly used after total knee arthroplasty (TKA) procedures; however, their use is somewhat controversial. Recently, some reports have claimed that the administration of tranexamic acid (TXA) may prevent postoperative bleeding following TKAs. Although numerous studies have reported regarding different dosages, timings of administration, or drain clamping times for intravenous and intra-articular TXA injections (IA-TXAs), few have examined whether suction drainage is necessary when TXA is administered. In this study, we compared using suction drainage without TXA administration and IA-TXA without suction drainage and aimed to examine the need for suction drainage during IA-TXA.

METHODS

This retrospective study was conducted on 217 patients who had received TKA for osteoarthritis; 104 were placed on suction drainage after TKA without TXA (Group A), whereas the remaining 113 received IA-TXA immediately after surgery without suction drainage (Group B). Our clinical evaluation included assessments of the need for transfusion, presence of postoperative complications, incidence of deep vein thrombosis (DVT), and changes in hemoglobin (Hb), hematocrit (Hct), and D-dimer levels.

RESULTS

No significant differences were observed in terms of postoperative complications and preoperative Hb, Hct, or D-dimer levels between the two groups. Although the prevalence of DVT was significantly higher in Group B (p < 0.05), all cases were asymptomatic. Hb and Hct levels were significantly lower in Group A than in Group B at 1, 3, 7, and 14 days postoperatively (p < 0.05), although none of the cases required blood transfusions. D-dimer levels were significantly higher in Group A than in Group B at 1 and 3 days postoperatively (p < 0.05).

CONCLUSION

Suction drainage might not be necessary when IA-TXA is administered after TKA procedures.

Effect of Knee Valgus Deformity on Symptomatic Venous Thromboembolism and Prosthesis Revision Risk after Total Knee Arthroplasty: A Multicenter Retrospective Study

OBJECTIVE

Symptomatic venous thromboembolism (VTE) and prosthesis failure are the most serious complications after total knee arthroplasty (TKA). However, whether knee valgus deformity aggravates these complications has not been fully clarified. To study the difference between perioperative symptomatic VTE and prosthesis revision rate in patients with valgus knee osteoarthritis by comparing with patients undergoing TKA for varus deformity and analyze the reasons for revision. At the same time, the distribution and radiographic features of lower extremity deep venous thrombosis were recorded.

METHODS

The data of patients who underwent TKA in two tertiary hospitals from January 2016 to December 2020 were retrospectively reviewed, and a total of 8917 patients were included. According to preoperative manifestations of knee malformations, all patients were divided into two groups: valgus group (n = 412) and varus group (n = 8505). Main indicators included the incidence of symptomatic VTE and prosthesis revision. Secondary outcomes included general information on operative time, Kellgren and Lawrence score, total hospital stay, and total costs. The patient data of the two groups were analyzed by Pearson chi-square test, Student t test, or Mann-Whitney U test. The revision was evaluated using Kaplan-Meier survival analysis.

RESULTS

The proportion of valgus knees in TKA patients was 4.62% (412/8917). The incidence of VTE was 6.23‰ (53/8505) and 16.99‰ (7/412) in the varus and valgus groups, and the results were statistically different (p = 0.009). There was no significant difference in echogenicity, number of occluded vessels, and thrombus length between the valgus group (p = 0.102; p = 0.645; p = 0.684). Patients with valgus deformity had 12.14‰ (5/412) prosthesis revision, the incidence of varus deformity was 4.82‰ (41/8505), and the revision risk of valgus group was 2.5 times higher than varus group, and the results were statistically different (p = 0.043). The operation time and hospital stay in the valgus group were longer than those in the varus group, and the results were statistically different (p = 0.018; p < 0.001).

CONCLUSIONS

Valgus deformity increases risk of symptomatic VTE and prosthesis revision after TKA. These results have guiding significance for the prevention of complications after TKA in patients with valgus deformity.

Effect of different application duration of a venous foot pump on prevention of venous thromboembolism after hip and knee arthroplasty: a multicenter prospective clinical trial

OBJECTIVE

To investigate the optimal duration of applying a venous foot pump (VFP) in the prevention of venous thromboembolism (VTE) following hip and knee arthroplasty.

METHODS

A total of 230 patients undergoing hip and knee arthroplasty between March 2021 and March 2022 in orthopaedic departments of four major teaching hospitals were prospectively enrolled. Patients were randomly divided into five groups based on the duration of the VFP application. Postoperative deep vein thromboses (DVT), including proximal, distal, and intermuscular DVT, were recorded for analysis. Postoperative blood coagulation examinations, such as D-dimer and active partial thromboplastin time (APTT), pain outcome, and degree of comfort were also collected.

RESULTS

Two of the 230 patients withdrew due to early discharge from the hospital, and 228 patients were included in the final analysis. The mean age was 60.38 ± 13.33 years. The baseline characteristics were comparable among the five groups. Compared with the other groups, patients treated with 6-hour VFP had the lowest incidence of DVT (8.7%, 4/46), followed by those treated with 1-hour VFP (15.2%, 7/46), 12-hour VFP (15.6%, 7/45), 18-hour VFP(17.8%, 8/45) and 20-hour VFP(21.7%, 10/46), but with no significant difference (P = 0.539). Regarding postoperative blood coagulation examinations, patients treated with 6-hour VFP had the lowest D-dimer (P = 0.658) and the highest APTT (P = 0.262) compared with the other four groups. 6-hour VFP also had the lowest pain score (P = 0.206) and the highest comfort score (P = 0.288) compared with the other four groups.

CONCLUSIONS

Six hours may be the optimal duration of applying VFP for the prevention of VTE in patients undergoing hip and knee arthroplasty in terms of VTE incidence, postoperative blood coagulation examinations, pain outcomes, and comfort scores.

Incidence and Distribution of Deep Vein Thrombosis Following Total Hip Arthroplasty Using an Anterolateral Supine Approach

Purpose

Venous thromboembolism (VTE) is a potential major complication in patients undergoing total hip arthroplasty (THA). However, the incidence of VTE following THA using anterolateral supine approach (ALS) has not been reported. The purpose of this study was to investigate the incidence of perioperative VTE and the distribution and characteristics of deep vein thrombosis (DVT) following ALS THA.

Patients and Methods

This retrospective single-arm study analyzed the 182 consecutive hips of 164 patients who underwent primary ALS THA. Pharmacological prophylaxis consisted of enoxaparin 20 mg twice daily for approximately 6 days starting 24 h postoperatively until duplex ultrasonography was performed to determine whether postoperative DVT was present. DVT was assessed by whole-leg Doppler ultrasound, and the location and characteristics of any thrombus were recorded. If pulmonary thromboembolism was suspected, contrast-enhanced computed tomography was performed.

Results

The overall incidence of VTE was 9.9% for DVT (18/182 hips) and 0.5% for pulmonary thromboembolism (1/182 hips). Most DVTs were in the soleal vein on the affected side and showed isoechoic or hypoechoic echogenicity. All thrombi were non-floating.

Conclusion

Following ALS THA with standard pharmacological prophylaxis and an early weight-bearing protocol, the incidence of perioperative DVT was approximately 10%, mostly occurring in the lower leg.

Robotic-assisted total knee arthroplasty is not associated with increased risk of postoperative deep vein thrombosis

PURPOSE

Prolongation of operation time due to registration and pin insertion has been reported with robotic-assisted total knee arthroplasty (RATKA), and there has been concern about an increase in the postoperative incidence of deep vein thrombosis (DVT). In this study, we compared the incidence of DVT after RATKA with that after conventional manual TKA (mTKA).

METHODS

This consecutive retrospective series included 141 knees that underwent primary TKA using the Journey II system. The CORI robot was used. There were 60 RATKAs and 81 mTKAs. Doppler ultrasound was performed in all patients on postoperative day 7 to determine whether DVT was present.

RESULTS

The operation time was longer in the RATKA cohort (99.5 min vs 78.0 min, p < 0.001). The overall incidence of DTV was 43.9% (62/141 knees), all of which were asymptomatic. There was no significant difference in incidence of DVT between RATKA and mTKA (50.0% vs 39.5%, p = 0.23). Use of the robot did not affect the incidence of DVT following TKA (odds ratio 1.02, 95% confidence interval 0.40-2.60; p = 0.96).

CONCLUSION

The incidence of DVT was not significantly different between RA-TKA and mTKA. Multiple logistic regression indicated that RATKA is not associated with increased risk of postoperative DVT.

LEVEL OF EVIDENCE

IV.