Hip Pelvis.  2012 Dec;24(4):279-287. 10.5371/hp.2012.24.4.279.

Deep Vein Thrombosis and Neurovascular Injury after Total Hip Arthroplasty

• Seo YS
• Yim SJ

• KMID: 1425043
• DOI: http://doi.org/10.5371/hp.2012.24.4.279

Abstract

Deep vein thrombosis (DVT) is a relatively common complication of total hip arthroplasty. DVT can accompany symptoms of pain and swelling of the lower leg, and can lead to fatal pulmonary thromboembolism. Surgical procedure is a primary risk factor, and obesity, medical status of disease, or patient's factors could be related. Diagnostic modalities include venography, Doppler ultrasound, CT angiography, and magnetic resonance venography. Mechanical prophylaxis, such as compression stocking and use of an intermittent pneumatic compression device or a pharmacological agent, such as Warfarin, low molecular weight heparin, thrombin inhibitors, and factor Xa inhibitor can be useful. Neurovascular injury after total hip arthroplasty is an uncommon complication, but can be disastrous and fatal. To prevent this complication, the surgeon must be well acquainted with the anatomy and proper surgical skill is needed.

Keyword

Total hip arthroplasty; Deep vein thrombosis; Neurovascular injury

MeSH Terms

Angiography
Arthroplasty
Factor Xa
Heparin, Low-Molecular-Weight
Hip
Leg
Magnetic Resonance Spectroscopy
Obesity
Phlebography
Pulmonary Embolism
Risk Factors
Stockings, Compression
Thrombin
Venous Thrombosis
Warfarin
Factor Xa
Heparin, Low-Molecular-Weight
Thrombin
Warfarin

Reference

1. Harris WH, Salzman EW, Athanasoulis C, Waltman AC, Baum S, DeSanctis RW. Comparison of warfarin, low-molecular-weight dextran, aspirin, and subcutaneous heparin in prevention of venous thromboembolism following total hip replacement. J Bone Joint Surg Am. 1974. 56:1552–1562.

2. Johnson R, Carmichael JH, Almond HG, Loynes RP. Deep venous thrombosis following Charnley arthroplasty. Clin Orthop Relat Res. 1978. (132):24–30.

3. Levine MN, Hirsh J, Gent M, et al. Prevention of deep vein thrombosis after elective hip surgery. A randomized trial comparing low molecular weight heparin with standard unfractionated heparin. Ann Intern Med. 1991. 114:545–551.

4. Lieberman JR, Geerts WH. Prevention of venous thromboembolism after total hip and knee arthroplasty. J Bone Joint Surg Am. 1994. 76:1239–1250.

5. Paiement GD, Beisaw NE, Harris WH, Wessinger SJ, Wyman EM. Advances in prevention of venous thromboembolic disease after elective hip surgery. Instr Course Lect. 1990. 39:413–421.

6. Leyvraz PF, Richard J, Bachmann F, et al. Adjusted versus fixed-dose subcutaneous heparin in the prevention of deep-vein thrombosis after total hip replacement. N Engl J Med. 1983. 309:954–958.

7. Sharrock NE, Brien WW, Salvati EA, Mineo R, Garvin K, Sculco TP. The effect of intravenous fixed-dose heparin during total hip arthroplasty on the incidence of deep-vein thrombosis. A randomized, double-blind trial in patients operated on with epidural anesthesia and controlled hypotension. J Bone Joint Surg Am. 1990. 72:1456–1461.

8. Turpie AG, Levine MN, Hirsh J, et al. A randomized controlled trial of a low-molecular-weight heparin (enoxaparin) to prevent deep-vein thrombosis in patients undergoing elective hip surgery. N Engl J Med. 1986. 315:925–929.

9. Kim YH, Choi IY, Park MR, Park TS, Cho JL. Prophylaxis for deep vein thrombosis with aspirin or low molecular weight dextran in Korean patients undergoing total hip replacement. A randomized controlled trial. Int Orthop. 1998. 22:6–10.

10. Yoo MC, Kang CS, Kim YH, Kim SK. A prospective randomized study on the use of nadroparin calcium in the prophylaxis of thromboembolism in Korean patients undergoing elective total hip replacement. Int Orthop. 1997. 21:399–402.

11. Westrich GH, Sánchez PM. Prevention and treatment of thromboembolic disease: an overview. Instr Course Lect. 2002. 51:471–480.

12. Anderson DR, O'Brien BJ, Levine MN, Roberts R, Wells PS, Hirsh J. Efficacy and cost of low-molecular-weight heparin compared with standard heparin for the prevention of deep vein thrombosis after total hip arthroplasty. Ann Intern Med. 1993. 119:1105–1112.

13. Binns M, Pho R. Femoral vein occlusion during hip arthroplasty. Clin Orthop Relat Res. 1990. (255):168–172.

14. Colwell CW Jr, Spiro TE, Trowbridge AA, et al. Enoxaparin Clinical Trial Group. Use of enoxaparin, a low-molecular-weight heparin, and unfractionated heparin for the prevention of deep venous thrombosis after elective hip replacement. A clinical trial comparing efficacy and safety. J Bone Joint Surg Am. 1994. 76:3–14.

15. Clagett GP, Anderson FA Jr, Levine MN, Salzman EW, Wheeler HB. Prevention of venous thromboembolism. Chest. 1992. 102:391S–407S.

16. Geerts WH, Code KI, Jay RM, Chen E, Szalai JP. A prospective study of venous thromboembolism after major trauma. N Engl J Med. 1994. 331:1601–1606.

17. Thomas DP. Venous thrombogenesis. Annu Rev Med. 1985. 36:39–50.

18. Planès A, Vochelle N, Fagola M. Total hip replacement and deep vein thrombosis. A venographic and necropsy study. J Bone Joint Surg Br. 1990. 72:9–13.

19. Jørgensen LN, Wille-Jørgensen P, Hauch O. Prophylaxis of postoperative thromboembolism with low molecular weight heparins. Br J Surg. 1993. 80:689–704.

20. Nielsen PT, Jørgensen LN, Albrecht-Beste E, Leffers AM, Rasmussen LS. Lower thrombosis risk with epidural blockade in knee arthroplasty. Acta Orthop Scand. 1990. 61:29–31.

21. Haas SB, Tribus CB, Insall JN, Becker MW, Windsor RE. The significance of calf thrombi after total knee arthroplasty. J Bone Joint Surg Br. 1992. 74:799–802.

22. Maynard MJ, Sculco TP, Ghelman B. Progression and regression of deep vein thrombosis after total knee arthroplasty. Clin Orthop Relat Res. 1991. (273):125–130.

23. Oishi CS, Grady-Benson JC, Otis SM, Colwell CW Jr, Walker RH. The clinical course of distal deep venous thrombosis after total hip and total knee arthroplasty, as determined with duplex ultrasonography. J Bone Joint Surg Am. 1994. 76:1658–1663.

24. Elias A, Aptel I, Huc B, et al. D-dimer test and diagnosis of deep vein thrombosis: a comparative study of 7 assays. Thromb Haemost. 1996. 76:518–522.

25. Bettmann MA, Paulin S. Leg phlebography: the incidence, nature and modification of undesirable side effects. Radiology. 1977. 122:101–104.

26. Amstutz HC, Friscia DA, Dorey F, Carney BT. Warfarin prophylaxis to prevent mortality from pulmonary embolism after total hip replacement. J Bone Joint Surg Am. 1989. 71:321–326.

27. Grady-Benson JC, Oishi CS, Hanson PB, Colwell CW Jr, Otis SM, Walker RH. Routine postoperative duplex ultrasonography screening and monitoring for the detection of deep vein thrombosis. A survey of 110 total hip arthroplasties. Clin Orthop Relat Res. 1994. (307):130–141.

28. Yoshimura N, Hori Y, Horii Y, Takano T, Ishikawa H, Aoyama H. Where is the most common site of DVT? Evaluation by CT venography. Jpn J Radiol. 2012. 30:393–397.

29. Coche EE, Hamoir XL, Hammer FD, Hainaut P, Goffette PP. Using dual-detector helical CT angiography to detect deep venous thrombosis in patients with suspicion of pulmonary embolism: diagnostic value and additional findings. AJR Am J Roentgenol. 2001. 176:1035–1039.

30. Montgomery KD, Potter HG, Helfet DL. Magnetic resonance venography to evaluate the deep venous system of the pelvis in patients who have an acetabular fracture. J Bone Joint Surg Am. 1995. 77:1639–1649.

31. Salvati EA, Pellegrini VD Jr, Sharrock NE, et al. Recent advances in venous thromboembolic prophylaxis during and after total hip replacement. J Bone Joint Surg Am. 2000. 82:252–270.

32. Hartman JT, Pugh JL, Smith RD, Robertson WW Jr, Yost RP, Janssen HF. Cyclic sequential compression of the lower limb in prevention of deep venous thrombosis. J Bone Joint Surg Am. 1982. 64:1059–1062.

33. Browse NL, Hall JH. Effect of dipyridamole on the incidence of clinically detectable deep-vein thrombosis. Lancet. 1969. 2:718–720.

34. Hull R, Delmore TJ, Hirsh J, et al. Effectiveness of intermittent pulsatile elastic stockings for the prevention of calf and thigh vein thrombosis in patients undergoing elective knee surgery. Thromb Res. 1979. 16:37–45.

35. Weitz J, Michelsen J, Gold K, Owen J, Carpenter D. Effects of intermittent pneumatic calf compression on postoperative thrombin and plasmin activity. Thromb Haemost. 1986. 56:198–201.

36. Gallus A, Raman K, Darby T. Venous thrombosis after elective hip replacement--the influence of preventive intermittent calf compression and of surgical technique. Br J Surg. 1983. 70:17–19.

37. Fordyce MJ, Ling RS. A venous foot pump reduces thrombosis after total hip replacement. J Bone Joint Surg Br. 1992. 74:45–49.

38. Balderston RA, Graham TS, Booth RE Jr, Rothman RH. The prevention of pulmonary embolism in total hip arthroplasty. Evaluation of low-dose warfarin therapy. J Arthroplasty. 1989. 4:217–221.

39. Barrack RL. Neurovascular injury: avoiding catastrophe. J Arthroplasty. 2004. 19:104–107.

40. Schmalzried TP, Amstutz HC, Dorey FJ. Nerve palsy associated with total hip replacement. Risk factors and prognosis. J Bone Joint Surg Am. 1991. 73:1074–1080.

41. Schmalzried TP, Noordin S, Amstutz HC. Update on nerve palsy associated with total hip replacement. Clin Orthop Relat Res. 1997. (344):188–206.

42. Nachbur B, Meyer RP, Verkkala K, Zürcher R. The mechanisms of severe arterial injury in surgery of the hip joint. Clin Orthop Relat Res. 1979. (141):122–133.

43. Wasielewski RC, Cooperstein LA, Kruger MP, Rubash HE. Acetabular anatomy and the transacetabular fixation of screws in total hip arthroplasty. J Bone Joint Surg Am. 1990. 72:501–508.

44. Brentlinger A, Hunter JR. Perforation of the external iliac artery and ureter presenting as acute hemorrhagic cystitis after total hip replacement. Report of a case. J Bone Joint Surg Am. 1987. 69:620–622.

45. Scullin JP, Nelson CL, Beven EG. False aneurysm of the left external iliac artery following total hip arthroplasty. Clin Orthop Relat Res. 1975. (113):145–149.

46. Johanson NA, Pellicci PM, Tsairis P, Salvati EA. Nerve injury in total hip arthroplasty. Clin Orthop Relat Res. 1983. (179):214–222.

47. Sunderland S. The anatomy and physiology of nerve injury. Muscle Nerve. 1990. 13:771–784.

48. Lazansky MG. Complications revisited. The debit side of total hip replacement. Clin Orthop Relat Res. 1973. (95):96–103.

49. Weber ER, Daube JR, Coventry MB. Peripheral neuropathies associated with total hip arthroplasty. J Bone Joint Surg Am. 1976. 58:66–69.