J Korean Med Sci.  2016 Mar;31(3):443-448. 10.3346/jkms.2016.31.3.443.

Is Routine Thromboprophylaxis Needed in Korean Patients Undergoing Unicompartmental Knee Arthroplasty?

Affiliations
  • 1Department of Orthopaedic Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea. iy1000@catholic.ac.kr
  • 2Department of Orthopaedic Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea.
  • 3Gangseo Himchan Hospital, Seoul, Korea.

Abstract

This study was undertaken to determine the prevalence and the natural course of venous thromboembolism (VTE) without thromboprophylaxis to ascertain whether routine thromboprophylaxis is necessary following unicompartmental knee arthroplasty (UKA) in Korean patients. The medical records and multidetector row computed tomography (MDCT) imaging of the consecutive 77 UKAs in 70 patients were reviewed. In all patients, MDCTs were undertaken preoperatively and at 1-week after surgery, and VTE symptoms were evaluated. At postoperative 6-months, follow-up MDCTs were undertaken in all patients in whom VTEs were newly detected after surgery. VTE lesions were newly detected in 18 (26%) of the 70 patients. However, none of the patients complained of VTE-related symptoms and MDCT demonstrated that all VTEs were small and involved limited portion without lower leg edema or pleuroparenchymal complication. At the 6-month follow up MDCT, all types of VTEs were shown to be completely resolved, regardless of their location. All of the VTE lesions maintained an asymptomatic status for 6-month after surgery. VTE following UKA in Korean patients who do not receive thromboprophylaxis seems to occur frequently, but all of the VTEs are clinically insignificant and all VTEs are spontaneously regressed. Routine thromboprophylaxis or thrombolytic treatment in Korean patients undergoing UKA may not be necessary.

Keyword

Venous Thromboembolism; Natural History; Arthroplasty; Replacement; Knee; Thromboprophylaxis

MeSH Terms

Aged
*Arthroplasty, Replacement, Knee
Asian Continental Ancestry Group
Female
Fibrinolytic Agents/therapeutic use
Humans
Knee/diagnostic imaging
Male
Middle Aged
Postoperative Complications
Republic of Korea
Retrospective Studies
Risk Factors
Tomography, X-Ray Computed
Venous Thromboembolism/diagnostic imaging/*prevention & control
Fibrinolytic Agents

Figure

  • Fig. 1 Prevalence of VTE following UKA in patients who did not receive thromboprophylaxis. The most common VTE lesion was isolated distal DVT (16%) followed by PE with concomitant distal DVT (7%) and isolated proximal DVT (3%).

  • Fig. 2 Serial MDCT venography images showing the natural course of postoperatively developed proximal DVT following unilateral UKA in a 71-year old female patient. Normal venous flows are observed at both proximal thighs preoperatively. Arrow indicates the left poplieal vein (A). Mild engorgement of the popliteal vein (arrow) is noted in the left proximal thigh at postoperative 1-week (B). At postoperative 6-month, the DVT lesion is completely regressed without thrombolytic treatment. Arrow indicates the left popliteal vein (C).

  • Fig. 3 Serial MDCT scans showing the natural course of postoperatively developed PE following unilateral UKA in a 58-year old female patient. Preoperative finding. Arrow indicates the posterior basal segmental artery of right lower lobe (A). Newly developed PEs are noted on bifurcation of the right middle and lower lobe at postoperative 1-week. Arrow indicates the posterior basal segmental artery of right lower lobe (B). These lesions are completely regressed at postoperative 6-month without treatment. Arrow indicates the posterior basal segmental artery of right lower lobe (C).


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