New recommendations from the American Academy of Orthopaedic Surgeons may help physicians prevent a potentially serious complication following knee and hip replacement procedures.
The AAOS has released an updated clinical practice guideline that recommends how to reduce the likelihood of blood clots after hip or knee replacement surgery. The new guideline suggests the use of preventive treatments and advises against routinely screening patients after surgery using ultrasound imaging.
Physicians should instruct patients to stop taking anticoagulants such as aspirin and clopidogrel (Plavix) before hip or knee replacement because of the increased risk of blood loss during surgery with these drugs.
The guideline also suggests that patients discuss the timing of stopping any medication with their physician. Patients may also want to have the surgery performed under regional anesthesia, such as epidural or spinal, rather than general anesthesia. Although evidence suggests that these regional approaches do not affect the occurrence of deep vein thrombosis or pulmonary embolism, they do limit blood loss.
Regarding care after hip or knee replacement, the guideline recommends that patients shouldn't have routine post-operative screening for thromboembolic disease with duplex ultrasonography. Screening with this test does not significantly reduce the rate of symptomatic DVT or PE, or the rate of fatal pulmonary embolism.
Patients should receive anticoagulant therapy and/or mechanical compression devices after a hip or knee replacement surgery. There is, however, insufficient evidence to recommend any particular preventive strategy, or the duration of these treatments. Patients should discuss the duration and type of preventive treatment with their physician. After hip or knee replacement, patients should get up and walk as soon as safely possible. Although there is sufficient evidence that early mobilization reduces DVT rates, early mobilization is low in cost, of minimal risk and consistent with current practice.
"Hip and knee arthroplasty is among the most successful of procedures in terms of restoring function and minimizing pain. However, one possible complication that orthopaedic surgeons are concerned about is venous thromboembolic disease," says Joshua Jacobs, MD, orthopaedic surgeon at Rush University Medical Center in Chicago, Ill., and chairman of the work group that developed the guideline.
Mark McGraw
