Abstract
Introduction
Venous thromboembolism (VTE) is one of the common complications after total hip replacements (THRs). To reduce the risk of VTE, early rising, active movement of the foot, the use of a foot pump or graduated compression stockings and prophylactic administration of anticoagulant drugs are important. Further, intraoperative factors should be taken intoãζζconsideration.
Objective
The objective of this study is to assess the influence of surgical approaches, which are a modified Watson-Jones approach and a posterolateral approach, on the frequency of VTE after primary THRs.
Materials and Methods
One hundred seventy-five patients underwent 199 primary total hip replacements by a single surgeon using modified Watson-Jones approach between gluteus medius muscle and tensor fascia lata (AL Group). The average age at the operation was 63.4 ±12.5 years old. The average BMI was 23.6±3.6. The original diagnosis consisted of 151 cases of osteoarthritis of the hip, 34 cases of avascular necrosis of the femoral head, 7 cases of rheumatoid arthritis and two cases of rapidly destructive coxopathies. Control group was 159 primary total hip replacements by a single surgeon using posterolateral approach (PL Group). The average age at the operation was 63.0±11.3 years old. The average BMI was 22.8±3.6. The original diagnosis consisted of 130 cases of osteoarthritis of the hip, 17 cases of avascular necrosis of the femoral head, 7 cases of rheumatoid arthritis and four cases of rapidly destructive coxopathies. VTE was detected by contrast computed tomography or ultrasound, and soluble fibrin monomer complex (SF) was measured on the first day after surgery.
Results
The frequency of VTE was thirty three of 199 cases (16.6%) in the AL Group. On the other hand, the frequency of VTE was sixty three of 159 cases (39.6%) in the PL Group. The average value of SF on the first day after surgery was 16.1±28.1 in the AL Group, 15.4±20.6 in the PL Group, respectively. In each group, the SF values showed a significant difference between VTE detected cases (41.7±55.3 in the AL Group; 24.2±26.4 in the PL Group) and VTE non-detected ones (10.9±13.6 in the AL Group; 9.4±12.4 in the PL Group) by Mann-Whitney U test.
Conclusion
Modified Watson-Jones approach is useful to reduce the risk of VTE, compared with posterolateral approach. The foot position to obstruct blood flow during THRs using poterolateral approach may be the risk factor for VTE.
