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Ulceration of the lower leg after total knee replacement

A FIVE-YEAR REVIEW

Department of Trauma and Orthopaedics, the Medical School, University of Newcastle upon Tyne, Framlington Place, Newcastle upon Tyne NE2 4HH, UK.

R. Morris, Senior Lecturer in Medical Statistics

Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Pond Street, London NW3 2QG, UK.

A. E. Crozier, FRCR, Consultant Radiologist

Glenfield Hospital, Groby Road, Leicester LE3 9UP, UK.

P. J. Gregg, MD, FRCS, Professor of Orthopaedics

Middlesborough General Hospital, Ayresome Green Lane, Middlesborough, Cleveland TS5 5AZ, UK.

Correspondence should be sent to Mr S. D. Muller.

Ulceration of the lower leg is considered to be a ‘hard’ clinical endpoint of venous thrombosis. Total knee replacement (TKR) is a significant risk factor for venous thrombosis of the leg and therefore potentially for ulceration.

We sent a postal questionnaire to 244 patients at a minimum of five years after TKR enquiring about the development of ulceration since their TKR. The overall incidence of ulceration, both active and healed, was 8.67% which is similar to that in the age-matched general population (9.6% to 12.6%), as was the prevalence of active ulceration. We also identified no clear association between venographically-confirmed postoperative deep-venous thrombosis (DVT) and the incidence and prevalence of ulcers at five years. We suggest that after TKR DVT is not a significant risk factor for ulceration of the leg and that perioperative chemical thromboprophylaxis may not be justified on these grounds.

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