Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Incidence of Venous Thromboembolism after Primary Total Hip Arthroplasty with Mechanical Prophylaxis in Hong Kong Chinese

  • Daniel Wai-Yip Wong (Total Joint Replacement Centre, Yan Chai Hospital) ;
  • Qunn-Jid Lee (Total Joint Replacement Centre, Yan Chai Hospital) ;
  • Chi-Kin Lo (Total Joint Replacement Centre, Yan Chai Hospital) ;
  • Kenneth Wing-Kin Law (Total Joint Replacement Centre, Yan Chai Hospital) ;
  • Dawn Hei Wong (Total Joint Replacement Centre, Yan Chai Hospital)
  • Received : 2023.07.25
  • Accepted : 2023.09.11
  • Published : 2024.06.01
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Abstract

Purpose: The incidence of deep vein thrombosis (DVT) following total hip arthroplasty (THA) without chemoprophylaxis could be as high as 50% in Caucasians. However, according to several subsequent studies, the incidence of venous thromboembolic events (VTE) in Asians was much lower. The routine use of chemoprophylaxis, which could potentially cause increased bleeding, infection, and wound complications, has been questioned in low-incidence populations. The objective of this study is to determine the incidence of VTE after primary THA without chemoprophylaxis in an Asian population using a fast-track rehabilitation protocol and to verify the safety profile for use of 'mechanical prophylaxis alone' in patients with standard risk of VTE. Materials and Methods: This is a retrospective cohort study of 542 Hong Kong Chinese patients who underwent primary THA without chemoprophylaxis. All patients received intermittent pneumatic compression and graduated compression stockings as mechanical prophylaxis. Multimodal pain management was applied in order to facilitate early mobilisation. Routine duplex ultrasonography was performed between the fourth and seventh postoperative day for detection of proximal DVT. Results: All patients were Chinese (mean age, 63.0±11.9 years). Six patients developed proximal DVT (incidence rate, 1.1%). None of the patients had symptomatic or fatal pulmonary embolism. Conclusion: The incidence of VTE after primary THA without chemical prophylaxis can be low in Asian populations when following a fast-track rehabilitation protocol. Mechanical prophylaxis alone can be regarded as a reasonably safe practice in terms of a balanced benefit-to-risk ratio for Asian patients with standard risk of VTE.

Keywords

Acknowledgement

Dr. Yiu-Chung Wong, former Director of the Total Joint Replacement Centre, Yan Chai Hospital, Hong Kong, for foundation of our center and being the chief surgeon of many of the cases included in the current study. Ms. Esther Wai-Yee Chang, Nursing Consultant, Kowloon West Cluster, Hospital Authority, Hong Kong, for establishing and operating the data base of the patients in our center.

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