Hip and knee replacement surgeries are counted among the most successful surgeries in restoring function and minimizing pain. More than 800,000 Americans undergo these operations every year. However, one of the most dreaded complications of these surgeries is the possibility of the patient developing venous thrombo-embolism. Deep Vein Thrombosis (DVT) or development of clot in the vessels of the leg can give rise to swelling and pain in the leg. In case the clot dislodges, it can travel to the lungs, leading to a fatal condition called as pulmonary embolism (PE). It has been seen that almost 37 percent of patients undergoing hip or knee replacement surgeries develop DVT subsequently.
The American Academy of Orthopedic Surgeons (AAOS) has released a clinical practice guideline to reduce the incidence of thrombo-embolism after hip and knee replacement surgeries. Some of the key recommendations are:
• Anticoagulants as well as medicines which interfere with blood clotting due to their action on platelets, like aspirin and clopidogrel should be stopped before the surgery to minimize blood loss.
• If the patient has had an episode of DVT or PE before, he should inform the surgeon about it. Such patients are more prone to develop these conditions again.
• The patient may be given the option of regional anesthesia, like spinal or epidural anesthesia. They are associated with reduced blood loss during surgery.
• After undergoing a hip or knee replacement surgery, the patient should not have routine duplex ultrasonography as a postoperative screening technique for thrombo-embolism. There is very little evidence to support the fact that this procedure can reduce the risk of thrombo-embolism.
• Patients should be administered anti-coagulant therapy in the post operative period unless his medical history does not allow this treatment.
• The patient should be encouraged to start walking as soon as possible after the surgery. Although there is no concrete evidence that early mobilization of the patient may reduce the incidence of thrombo-embolism, it is a routine practice associated with minimal risk.
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