The John Charnley Award: heritable thrombophilia and development of thromboembolic disease after total hip arthroplasty.
We retrospectively assessed whether heritable thrombophilia-hypofibrinolysis was more common in patients developing venous thromboembolism after total hip replacement than among control patients who did not develop venous thromboembolism, as an approach to better identify causes of venous thromboembolism after total hip arthroplasty. Twenty patients with proximal deep venous thrombosis after THA and 23 patients with symptomatic pulmonary embolism were compared with 43 control patients who did not have postoperative venous thromboembolism. Five of 42 patients with venous thromboembolism (12%) and 0 of 43 control patients (0%) had antithrombin III deficiency (< 75%). Nine of 42 patients with venous thromboembolism (21%) and 2 of 43 control patients (4.7%) had protein C deficiency (< 70%). Ten of 43 patients with venous thromboembolism (9 heterozygous, 1 homozygous; 23%) and 1 of 43 control patients (heterozygous; 2%) had the prothrombin gene mutation. Patients who had venous thromboembolism after total hip arthroplasty were more likely than matched control patients to have heritable thrombophilia with antithrombin III or protein C deficiency, or homo-heterozygosity for the prothrombin gene mutation. Screening for these three tests of heritable thrombophilia before total hip arthroplasty should improve the identification of patients with a reduced risk of venous thromboembolism who may need only mild thromboprophylaxis, and of those patients with heritable thrombophilia in whom prophylaxis should be more aggressive.


METHODS
Prognostic study, Level II-1 (lesser-quality RCT). See the Guidelines for Authors for a complete description of levels of evidence.
Salvati
Eduardo A
EA
Hospital for Special Surgery, New York, NY 10021, USA. salvatie@hss.edu
Della Valle
Alejandro González
AG
Westrich
Geoffrey H
GH
Rana
Adam J
AJ
Specht
Lawrence
L
Weksler
Babette B
BB
Wang
Ping
P
Glueck
Charles J
CJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020152:Antithrombin III Deficiency / Q000191:economics / Q000453:epidemiology / Q000235:genetics; D019644:Arthroplasty, Replacement, Hip / Q000191:economics / Q000706:statistics & numerical data*; D004617:Embolism / Q000191:economics / Q000453:epidemiology / Q000209:etiology; D005260:Female; D017048:Health Care Costs; D006579:Heterozygote; D006720:Homozygote; D006801:Humans; D007020:Hypoprothrombinemias / Q000191:economics / Q000453:epidemiology / Q000235:genetics; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D011379:Prognosis; D020151:Protein C Deficiency / Q000191:economics / Q000453:epidemiology / Q000235:genetics; D012189:Retrospective Studies; D012307:Risk Factors; D019851:Thrombophilia / Q000191:economics / Q000453:epidemiology* / Q000235:genetics*; D020246:Venous Thrombosis / Q000191:economics / Q000453:epidemiology* / Q000235:genetics*