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Venous thromboembolic prophylaxis after total joint arthroplasty

    Vamsi Aribindi

    Vamsi Aribindi is a second year medical student at the Keck School of Medicine of the University of Southern California (USC; USA), actively involved in the Health, Technology, and Engineering Program, an interdisciplinary program between the Keck School of Medicine and the USC Viterbi School of Engineering. He leads a start-up team, which has won the USC Stevens Innovation Award and seed funding for a medical device concept. He is a recipient of the 2014 American College of Medical Quality Student Quality Scholar Award. He graduated from the Massachusetts Institute of Technology (USA) in 2012 with a degree in Aerospace Engineering, specializing in information technology.

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    &
    Jay R Lieberman

    Jay R Lieberman is Professor and Chairman of the Department of Orthopedic Surgery at the Keck School of Medicine of the University of Southern California (USA). He is a nationally renowned total joint arthroplasty surgeon. He is a member of The Hip Society, The Knee Society and The International Hip Society. He was Chairman of the education committee for the American Association of Hip and Knee Surgeons and he will assume the presidency of the American Association of Hip and Knee Surgeons in 2015. He is the Deputy Editor for hip and knee reconstruction for the Journal of the American Academy of Orthopaedic Surgeons and he also edited the highly popular AAOS Comprehensive Orthopaedic Review. His basic science research focus is on the development of regional gene therapy to enhance bone repair and understanding the role of growth factors in influencing the biological activity of stem cells and osteoprogenitors. He has received the Marshall R Urist Award from the Orthopaedic Research Society and the Kappa Delta Elizabeth Winston Lanier Research Award from the American Academy of Orthopaedic Surgeons in recognition of this work. He has also received the Frank Stinchfield Award from The Hip Society and he was an American–British–Canadian Traveling Fellow. He has published more than 110 peer-reviewed articles and 90 book chapters and reviews.

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    Published Online:14 Aug 2014https://doi.org/10.2217/fmeb2013.13.291
    Abstract:

    Both total knee arthroplasty and total hip arthroplasty are successful operations that can improve a patient’s quality of life. Unfortunately, some patients will develop symptomatic pulmonary embolism or deep vein thrombosis after this surgery. If no prophylaxis is used, historical data suggest that 40–60% of patients will develop an asymptomatic deep vein thrombosis and that 0.5–2% of patients may die of a pulmonary embolism [1,2]. If modern prophylaxis techniques are used, these rates are reduced to 0.5–1% of patients who will ever develop a symptomatic venous thromboembolism (VTE), although significant variation in rates exist [3]. Therefore, there is great interest among surgeons in providing patients with appropriate VTE prophylaxis. The selection of the specific VTE regimen is a balance between efficacy and safety. Orthopedic surgeons are particularly concerned about postoperative bleeding, which can lead to reoperation for evacuation of a hematoma, infection and limited range of motion in a total knee arthroplasty [4]. At the present time, the ideal prophylaxis regimen has not been identified but clinical practice guidelines have been developed that can be useful to orthopedic surgeons in selecting an appropriate prophylaxis regimen for their patients.

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