Not All Patients Undergoing Hip Arthroscopy Need DVT Prophylaxis
In a prospective study from Canada, the incidence of deep vein thrombosis after hip arthroscopy was less than 5% in patients with no known risk factors for DVT.
What deep vein thrombosis (DVT) prophylaxis should be ordered when a patient has an elective hip arthroscopy procedure?
Depending on the patient, none.
That’s the finding of researchers from the University of Calgary Sport Medicine Centre, Calgary, Alberta, Canada, who presented their paper at the 2015 ISAKOS Biennial Congress in Lyon, France.
Because of the retrospective nature of DVT and pulmonary embolism (PE) incidence rates in the literature, orthopaedic surgeons have been unsure about what they should – or shouldn’t – do regarding DVT prophylaxis in hip arthroscopy patients.
The researcher from Calgary sought to bring some clarity to the issue with a prospective study of DVT incidence based on Doppler ultrasound evaluation of patients who underwent elective hip arthroscopy without pharmacologic or mechanical prophylaxis.
Patients were carefully screened to ensure they did not have a previous thromboembolic event, known prothrombotic condition, systemic symptomatic medical disease, or septic arthritis. Those with third party compensation also were not eligible for the study.
The study included 115 consecutive patients (55 males, 60 females) with a mean age of 34.9 years. They did not receive DVT prophylaxis, but were encouraged to mobilize as soon after the procedure as possible.
The researchers evaluated these patients 2 weeks after the procedure, looking for signs and symptoms of DVT or PE:
- Calf erythema and swelling
- Calf pain
- Shortness of breath
- Pleuritic chest pain
Compressibility of the proximal deep venous system was assessed with bilateral duplex color ultrasonography 10 to 21 days after the procedure.
The primary outcome was frequency of DVT, as diagnosed by Doppler ultrasound. Between day 2 and day 22 after surgery, the researchers confirmed 5 cases of DVT among the 115 patients in the study, for an overall incidence of less than 5%.
The mean age of the 5 patients with a DVT was somewhat older than the mean age of the patients without a DVT (43.8 vs. 35.5 years, respectively), and the average traction time was lower for DVT patients than for non-DVT patients (38 vs. 61 minutes, respectively).
Other risk factors (surgical procedure, weight-bearing status after the procedure, mobilization, use of non-steroidal anti-inflammatory drugs) were similar between groups.
Of the 5 patients diagnosed with DVT:
- 4 were symptomatic and 1 was asymptomatic
- 3 were diagnosed because of symptoms requiring an emergency assessment and evaluation
- 1 had a suspected DVT at the first postoperative visit that was confirmed with Doppler ultrasound
- 4 had a DVT restricted to the calf veins; 1 had involvement of the popliteal vein
- None had had proximal extension into the thigh or pelvis
Because incidence of DVT was so low, the researchers recommend against routine pharmacologic or mechanical DVT prophylaxis in this patient population – ie, those with no known risk factors for DVT.
They noted, however, that, “the significance of calf DVT and whether or not treatment is needed for symptomatic patients remains to be fully elucidated.”
Mohtadi N, Johnston K, Gaudelli, et al. The Incidence of Proximal Deep Vein Thrombosis after Elective Hip Arthroscopy: A Prospective Cohort Study (Paper 111). Presented at the 2015 ISAKOS Biennial Congress, June 7-11, 2015, Lyon France.