INTEREST OF SYSTEMATIC POSTOPERATIVE VENOUS CONTROL IN AN ORTHOPAEDIC UNIT

Abstract

Purpose: Is prevention of postoperative venous thrombosis using low-molecular-weight heparin (LMWH) sufficient in orthopaedic and traumatology units?

Material and methods: Between 1995 and 2000, all patients undergoing orthopaedic or traumatology procedures involving the lower limb underwent a venous control the sixth day after surgery: RPO with phlebography if positive until September 1996 then duplex Doppler of the lower limbs. In all 755 patients, mean age 68 years (34–90), undergoing planned orthopaedic procedures (341 THA, 135 TKA, 111 tibial osteotomies, 66 single compartment prostheses, cruciate surgery) or procedures for trauma (56 femoral neck, trochanter, bimalleolar, etc.) were included.

Results: A total of 118 cases of deep vein thrombosis were discovered giving an incidence of 16%. The deep vein thrombosis was in the sural territory in 95 cases (posterior tibial, fibular, vastus and/or anterior tibial) but there were also 13 cases of proximal thrombosis in the iliofemoral or femoral localisations. The large majority of the cases were homolateral to the surgical side, eight were found in the other limb. In this series, the venous risk differed from one surgical procedure to another (for the same operator): 11% for THA, 22% for TKA (without tourniquet) and 17 to 12.5% for tibial osteotomies with tourniquet (valgisation and transposition of the anterior tuberosity), 13.5 % for single compartment prostheses with tourniquet. Our oldest patient was 90 years old and was treated by intermediary arthroplasty for a cervical fracture. The youngest were 34 years old for anterior cruciate ligament surgery or valgisation osteotomy and 38 and 39 years for THA subsequent to advanced necrosis. Finally, there was no statistical difference by sex.

Conclusion: Systematic use of duplex Doppler examination of both limbs postoperatively revealed a large number of deep vein thrombosis patients despite systematic use of LMWH which certainly modified their clinical presentation. These patients were then given adapted treatment which led to regression of the complications: postphlebitis syndrome and pulmonary embolism with the risk of medicolegal complications.