Does total hip arthroplasty predispose to chronic venous insufficiency?
One hundred thirty-four limbs (40% retrieval) were reviewed 14 to 21 years after total hip arthroplasty. Each had been screened for deep vein thrombosis following surgery by the fibrinogen uptake test, with proximal thrombi confirmed venographically. The limbs were assessed for chronic venous insufficiency with a standard clinical grade and photoplethysmography. Clinical chronic venous insufficiency was found in 4 of 36 (12%) limbs without and 11 of 98 (11%) with previous thrombosis (chi-square = .09, P = .77). Clinical chronic venous insufficiency was detected in 9% of limbs (6/67) with calf thrombi, 0% of limbs (0/11) with isolated femoral thrombi, and 25% of limbs (5/20) with calf and femoral thrombi. After photoplethysmographic assessment, only 2 of 98 (2%) cases were thought to be attributable to thrombosis after hip arthroplasty (95% confidence interval, 0.2-7.2). Despite a high incidence of deep vein thrombosis diagnosed on the fibrinogen uptake test after total hip arthroplasty, symptomatic deep chronic venous insufficiency was an unusual outcome 14 to 21 years later.
Warwick
D
D
Avon Orthopaedic Centre, Bristol, United Kingdom.
Perez
J
J
Vickery
C
C
Bannister
G
G
D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007866:Leg / Q000098:blood supply; D017156:Photoplethysmography; D013924:Thrombophlebitis / Q000453:epidemiology / Q000209:etiology; D014689:Venous Insufficiency / Q000175:diagnosis / Q000209:etiology*