Dhupar Scott, Iorio Richard, Healy William L, Dhimitri Kenneth
Department of Orthopaedic Surgery, Lahey Clinic Medical Center, Burlington, MA 01805, USA.
J Bone Joint Surg Am. 2006 Nov;88(11):2380-5. doi: 10.2106/JBJS.E.00870.
Thromboembolic disease in the form of deep venous thrombosis and pulmonary embolism is a risk following hip and knee joint replacement. Prophylactic and screening protocols have been employed to prevent thromboembolic disease following lower extremity joint reconstruction. The purpose of the present study was to evaluate two noninvasive venous screening protocols, specifically, compression ultrasonography performed either at the time of hospital discharge or two weeks after the operation.
From 1994 through 2001, 2364 patients undergoing primary unilateral total hip or total knee arthroplasty were managed with an anticoagulation chemoprophylaxis protocol (adjusted-dose warfarin) until the time of noninvasive venous screening with use of one of two protocols. Nine hundred thirty-one patients (406 hips and 525 knees) underwent compression ultrasonography prior to hospital discharge, and the other 1433 patients (614 hips and 819 knees) underwent ultrasonographic screening two weeks after the operation.
Twenty-three proximal deep venous thromboses (prevalence, 2.5%) were identified in the group that underwent ultrasound screening at the time of hospital discharge, and thirty-one proximal thromboses (prevalence, 2.2%) were identified in the group that underwent ultrasound screening two weeks after the operation. There was no significant difference between the two protocols with regard to the detection of deep venous thrombosis.
There was no significant difference between the group that received two weeks of warfarin chemoprophylactic prophylaxis and the group that was screened at the time of hospital discharge with regard to the detection of deep venous thrombosis with use of compression ultrasound. On the basis of these findings, we no longer screen asymptomatic patients for deep venous thrombosis following hip and knee replacement, and all patients receive warfarin anticoagulation for two weeks.
深静脉血栓形成和肺栓塞形式的血栓栓塞性疾病是髋关节和膝关节置换术后的一种风险。已采用预防和筛查方案来预防下肢关节重建术后的血栓栓塞性疾病。本研究的目的是评估两种非侵入性静脉筛查方案，具体而言，即在出院时或术后两周进行的加压超声检查。
从1994年至2001年，2364例接受初次单侧全髋关节或全膝关节置换术的患者采用抗凝化学预防方案（调整剂量华法林）进行治疗，直至使用两种方案之一进行非侵入性静脉筛查时。931例患者（406例髋关节和525例膝关节）在出院前接受了加压超声检查，另外1433例患者（614例髋关节和819例膝关节）在术后两周接受了超声筛查。
在出院时接受超声筛查的组中发现了23例近端深静脉血栓形成（患病率为2.5%），在术后两周接受超声筛查的组中发现了31例近端血栓形成（患病率为2.2%）。两种方案在深静脉血栓形成的检测方面没有显著差异。
在使用加压超声检测深静脉血栓形成方面，接受两周华法林化学预防的组与出院时接受筛查的组之间没有显著差异。基于这些发现，我们不再对髋关节和膝关节置换术后的无症状患者进行深静脉血栓形成筛查，所有患者均接受两周的华法林抗凝治疗。
