Faculty Opinions recommendation of Symptomatic in-hospital deep vein thrombosis and pulmonary embolism following hip and knee arthroplasty among patients receiving recommended prophylaxis: a systematic review.

Abstract Background The use of the tourniquet in total knee arthroplasty is still a subject of controversial discussion. Previous studies mainly focus on parameters like blood loss and operation time. The aim of this systematic review is to evaluate the postoperative outcome involving parameters such as pain intensity, analgesic consumption, knee function and complication rate with and without tourniquet use, to find a recommendation for future application in total knee arthroplasty. Material and Methods This review is based on the PRISMA Checklists. A systematic research was performed in PubMed using the key words “tourniquet”, “total knee arthroplasty”, “TKA” and “knee endoprosthesis” up to and including January 2018. The initial search revealed 686 Papers which were extracted by the parameters intensity of pain, analgesic consumption, function (range of motion, Hospital for Special Surgery Score, Knee Society Score) and complications (deep vein thrombosis, surgical side infection, pulmonary embolism). The program Review Manager Version 5.3 was used for statistical analysis. A significance level of p < 0,05 was defined. Results 18 studies were included in this review with 1279 total knee arthroplasties overall (646 with the use of tourniquet and 633 without). The analysis shows a significant lower pain intensity until the fifth postoperative day (p = 0,03) and also after one to three months (p = 0,04) without using the tourniquet. Range of motion is significantly higher in two to three days postoperatively (p < 0,00 001) when the surgery was performed without tourniquet. Knee Society Score shows no difference between the two groups. A deep vein thrombosis appears significantly more often when using a tourniquet (p = 0,04). There was no higher occurrence in pulmonary embolism and surgical side infections. Conclusion The use of a pneumatic tourniquet in total knee arthroplasty affects especially the early postoperative pain and functional recovery.

Download Full-text

Physician compliance with guidelines for deep-vein thrombosis prevention in total hip and knee arthroplasty

Current Medical Research and Opinion ◽

10.1185/030079907x242746 ◽

2008 ◽

Vol 24 (1) ◽

pp. 87-97 ◽

Cited By ~ 88

Author(s):

Richard J. Friedman ◽

Alexander S. Gallus ◽

Fred D. Cushner ◽

Gordon Fitzgerald ◽

Frederick A. Anderson ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Knee Arthroplasty ◽

Total Hip ◽

Vein Thrombosis ◽

Physician Compliance ◽

Hip And Knee Arthroplasty ◽

Deep Vein

Download Full-text

Has the incidence of deep vein thrombosis in patients undergoing total hip/knee arthroplasty changed over time? A systematic review of randomized controlled trials

Thrombosis Research ◽

10.1016/j.thromres.2008.05.005 ◽

2008 ◽

Vol 123 (1) ◽

pp. 24-34 ◽

Cited By ~ 48

Author(s):

Katharine He Xing ◽

Gareth Morrison ◽

Wendy Lim ◽

James Douketis ◽

Adefowope Odueyungbo ◽

...

Keyword(s):

Systematic Review ◽

Deep Vein Thrombosis ◽

Randomized Controlled Trials ◽

Knee Arthroplasty ◽

Controlled Trials ◽

Total Hip ◽

Vein Thrombosis ◽

Randomized Controlled ◽

Deep Vein ◽

Over Time

Download Full-text

One Versus Two Doses of Intravenous Tranexamic Acid in Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0039-1700805 ◽

2019 ◽

Author(s):

Ryan S. Charette ◽

Jenna A. Bernstein ◽

Matthew Sloan ◽

Corbyn M. Nchako ◽

Atul F. Kamath ◽

...

Keyword(s):

Pulmonary Embolism ◽

Total Knee Arthroplasty ◽

Deep Vein Thrombosis ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Transfusion Rate ◽

Vein Thrombosis ◽

Total Knee ◽

Deep Vein

AbstractTranexamic acid (TXA) has been shown to reduce blood loss and postoperative transfusions in total knee arthroplasty (TKA). There is no consensus on the ideal dosing regimen in the literature, although there is a growing body of literature stating there is little benefit to additional doses. Our study compared one versus two doses of TXA in primary TKA and its effect on postoperative transfusion rate. We retrospectively reviewed patients undergoing primary TKA at our two high-volume arthroplasty centers between 2013 and 2016. Patients were included if they underwent unilateral primary TKA, and received one or two doses of intravenous TXA. Patients receiving therapeutic anticoagulation were excluded. Our primary outcome was postoperative transfusion rate. Secondary outcomes included blood loss, length of stay, rate of deep vein thrombosis or pulmonary embolism (DVT/PE), readmission and reoperation.A total of 1,191 patients were included: 891 received one dose and 300 received two doses. There was no significant difference in rate of transfusion, deep vein thrombosis or pulmonary embolism (DVT/PE), blood volume loss, and reoperation. There was a significantly higher risk of readmission (6.7 vs. 2.4%, odds ratio [OR] 2.96, p < 0.001) and reoperation (2.0 vs. 0.6%, OR 3.61, p = 0.024) in patients receiving two doses. These findings were similar with subgroup analysis of patients receiving only aspirin prophylaxis.In unilateral TKA, there is no difference in transfusion rate with one or two doses of perioperative TXA. There was no increased risk of thromboembolic events between groups, although the two-dose group had a higher rate of readmission and reoperation. Given the added cost without clear benefit, these findings may support administration of one rather than two doses of TXA during primary TKA.

Download Full-text

Trends in Deep Vein Thrombosis Prophylaxis and Deep Vein Thrombosis Rates After Total Hip and Knee Arthroplasty

Journal of the American Academy of Orthopaedic Surgeons ◽

10.5435/jaaos-d-18-00635 ◽

2018 ◽

Vol 26 (23) ◽

pp. 852

Keyword(s):

Deep Vein Thrombosis ◽

Knee Arthroplasty ◽

Thrombosis Prophylaxis ◽

Total Hip ◽

Vein Thrombosis ◽

Deep Vein Thrombosis Prophylaxis ◽

Hip And Knee Arthroplasty ◽

Deep Vein

Download Full-text

Retrospective Derivation and Validation of an Automated Electronic Search Algorithm to Identify Post operative Cardiovascular and Thromboembolic Complications

Applied Clinical Informatics ◽

10.4338/aci-2015-03-ra-0026 ◽

2015 ◽

Vol 06 (03) ◽

pp. 565-576 ◽

Cited By ~ 9

Author(s):

M. Tien ◽

R. Kashyap ◽

G. A. Wilson ◽

V. Hernandez-Torres ◽

A. K. Jacob ◽

...

Keyword(s):

Myocardial Infarction ◽

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Knee Arthroplasty ◽

Search Algorithm ◽

Cardiovascular Complications ◽

Data Abstraction ◽

Vein Thrombosis ◽

Electronic Search ◽

Deep Vein

Summary Background: With increasing numbers of hospitals adopting electronic medical records, electronic search algorithms for identifying postoperative complications can be invaluable tools to expedite data abstraction and clinical research to improve patient outcomes. Objectives: To derive and validate an electronic search algorithm to identify postoperative thromboembolic and cardiovascular complications such as deep venous thrombosis, pulmonary embolism, or myocardial infarction within 30 days of total hip or knee arthroplasty. Methods: A total of 34 517 patients undergoing total hip or knee arthroplasty between January 1, 1996 and December 31, 2013 were identified. Using a derivation cohort of 418 patients, several iterations of a free-text electronic search were developed and refined for each complication. Subsequently, the automated search algorithm was validated on an independent cohort of 2 857 patients, and the sensitivity and specificities were compared to the results of manual chart review. Results: In the final derivation subset, the automated search algorithm achieved a sensitivity of 91% and specificity of 85% for deep vein thrombosis, a sensitivity of 96% and specificity of 100% for pulmonary embolism, and a sensitivity of 100% and specificity of 95% for myocardial infarction. When applied to the validation cohort, the search algorithm achieved a sensitivity of 97% and specificity of 99% for deep vein thrombosis, a sensitivity of 97% and specificity of 100% for pulmonary embolism, and a sensitivity of 100% and specificity of 99% for myocardial infarction. Conclusions: The derivation and validation of an electronic search strategy can accelerate the data abstraction process for research, quality improvement, and enhancement of patient care, while maintaining superb reliability compared to manual review. Citation: Tien M, Kashyap R, Wilson GA, Hernandez-Torres V, Jacob AK, Schroeder DR, Mantilla CB. Retrospective Derivation and Validation of an Automated Electronic Search Algorithm to Identify Postoperative Thromboembolic and Cardiovascular Complications. Appl Clin Inform 2015; 6: 565–576http://dx.doi.org/10.4338/ACI-2015-03-RA-0026

Download Full-text