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Lower limb arthroplasty complicated by deep venous thrombosis

PREVALENCE AND SUBJECTIVE OUTCOME

Glan Clwyd Hospital, Sarn Lane, Rhyl, Denbighshire LL18 5UJ, UK.

S. C. Williams, FRCS Orth, Lecturer in Orthopaedic Surgery; and W. M. Harper, MD, Professor of Trauma Surgery

University Department of Orthopaedic Surgery, Glenfield General Hospital, Groby Road, Leicester LE3 9QP, UK.

P. J. Gregg, MD, Consultant Orthopaedic Surgeon and Professor of Orthopaedic Surgical Science

Department of Orthopaedic and Trauma Surgery, Middlesborough General Hospital, Ayresome Green Lane, Middlesborough TS5 5AZ, UK.

Correspondence should be sent to Mr J. A. Cordell-Smith at 18 Llewelyn Goch, Cae Derwen, Saint Fagans, Cardiff CF5 6HR, Wales.

The aim of this study was to determine the prevalence of deep venous thrombosis (DVT) following lower limb arthroplasty and to assess whether this adversely affected satisfaction, relief from pain, or the level of mobility as perceived by patients. Six hundred and ten consecutive recipients of primary total hip replacement (THR) or total knee replacement (TKR) underwent routine post-operative venography. The functional outcome had already been assessed at one year by using the Regional Arthroplasty Database questionnaire, the results of which were correlated to venographic records.

The combined prevalence of DVT after THR and TKR in the patients, who did not receive chemical thromboprophylaxis, was 46.4%. Thrombus was identified in 57.6% of those with a TKR and in 33.5% of patients with a THR. Proximal thrombus was found in 11.0% of TKRs and in 14.8% of THRs. One year after surgery, patients who had a DVT established by venography did not report higher levels of immobility (p = 0.07), discomfort (p = 0.12) or dissatisfaction (p = 0.23) when compared to those with patent venous systems.

This suggests that the prevalence of DVT following TKR/THR without chemical thromboprophylaxis is high and these findings are consistent with the literature. However, patients did not perceive thrombosis to compromise their overall outcome. This challenges the belief that DVT is associated with morbidity and calls for further comprehensive research in this area. The low morbidity of the lower limb associated with DVT in these patients does not support the use of chemical thromboprophylaxis.

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