[Rate of venous thromboembolism after total hip and total knee replacement in inpatient orthopedic rehabilitation].
OBJECTIVE
The current incidence of total hip and total knee replacements in Germany amounts to approximately 320,000 per year. A high rate of asymptomatic deep vein thromboses causes venous thromboembolisms which are the most common complications after these operations. Partly, these venous thromboembolisms occur during or even after rehabilitation. We try to reduce symptomatic venous thromboembolisms during/after inpatient rehabilitation by mandatory examination of all patients with total hip and total knee replacement by means of compression/duplex ultrasound and a structured prophylaxis and therapy regimen.


METHODS
572 patients after total knee replacement and 609 patients after total hip replacement were examined by compression/duplex ultrasound during postoperative inpatient rehabilitation in Medical Park St. Hubertus, Bad Wiessee, Germany. Prophylaxis and therapy of thrombo embolic complications were performed according to the current guidelines. 3 months after rehabilitation, patients were questioned as to whether a thrombo embolic event had occurred or not.


RESULTS
Out of 572 patients with total knee replacement, a total of 127 developed a thrombosis or lung embolism (22.2%), namely muscle vein thrombosis in 44 (7.7%), proximal thrombosis in eleven (1.9%), and lung embolism in five cases (0.9%). Out of 609 patients after total hip replacement, 37 showed a thrombosis or lung embolism (6.1%), that is 15 cases of muscle vein thrombosis (2.5%), six cases of proximal thrombosis (1.0%), and four cases of lung embolism (0.7%). An extra three patients developed lung embolism after rehabilitation, two of them because of a proximal thrombosis in the contralateral leg (without surgery), and one patient because of a progressive muscle vein thrombosis that turned into a proximal thrombosis. In 15 cases (9.4% of all thromboses), the thrombosis occurred in the contralateral leg (without surgery)


CONCLUSIONS
In spite of consistent prophylaxis, a high rate of thrombosis occurs, partly also in the contralateral leg.
Abteilung Orthopädie/Sportmedizin, Medical Park St. Hubertus, Bad Wiessee, Germany. c.musselmann@medicalpark.de
Christian
C
Musselmann
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation* / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D005260:Female; D005858:Germany; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D053828:Stockings, Compression; D018616:Ultrasonography, Doppler, Duplex; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000517:prevention & control
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight