POST-THROMBOTIC SYNDROME FOLLOWING LOWER LIMB ARTHROPLASTY

Abstract

The aims of the study were to determine the prevalence of post thrombotic syndrome following lower limb arthroplasty in patients who did not receive chemical thromboprophylaxis, and identify morbidity associated with the condition. From the Trent regional arthroplasty database patients 5 years post elective total knee or hip replacement were identified. All patients were under the care of two senior orthopaedic consultants who performed surveillance venography between the 7th and 10th postoperative day. Prophylaxis for DVT was in the form of below knee compression stockings. Above knee DVTs were anticoagulated, below knee compression stockings was administered for below knee DVT.

Two doctors conducted a clinical review in the manner suggested by the American Venous Forum Executive Committee. Clinical examination was used to assess the presence and class of post-thrombotic syndrome. 71 patients were reviewed. With respect to the ipsilateral limb, there were 32 patients with a DVT and 39 without DVT. Six classes excluding normal, class 0, are used to describe the clinical findings. 17 (24%) patients had no visible sign of venous disease (class 0). 14 (20%) patients suffered minor venous disease (class 1). 28 (39%) patients had established varicose veins (class 2). 2 (3%) patients had oedema without skin changes (class 3). 8 (11%) patients had skin changes ascribed to venous disease ie. pigmentation, venous eczema, lipodermato-sclerosis (class 4). 2 (3%) patient had skin changes as defined with healed ulceration. No patient had skin changes as defined previously with active ulceration (class 6).

Minor venous disease (classes 1 & 2) is common and seen in 44% of DVT negative and 78% of DVT positive patients in this study. Severe venous (classes 3,4 & 5) disease is uncommon and seen in 20% of DVT negative and 13% of DVT positive patients in the study. Symptomatic patients were equally distributed between DVT positive and negative groups. Severe venous disease was more common in the DVT negative group. Concluding, minor venous disease is common post lower limb arthroplasty, severe disease occurred in 17% of patients and appeared unrelated to a previous DVT. The presence of a DVT does not influence the development of skin changes of post-thrombotic limb.