Orthonotes
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Risk high in hip/knee arthroplasty, hip fracture surgery, pelvic/acetabular trauma, prolonged immobility. Options: LMWH, DOACs (apixaban/rivaroxaban), aspirin (selected low‑risk arthroplasty), mechanical methods (IPC/stockings). Duration: 10–14 days minimum; up to 35 days after hip fracture/arthroplasty. Balance bleeding risk (neuraxial anesthesia timing) with VTE prevention.
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Deep vein thrombosis (DVT) is a serious complication that may occur after orthopaedic trauma or surgery. It involves the formation of thrombi within the deep venous system, most commonly in the veins of the lower limbs. If untreated, these thrombi may dislodge and travel to the lungs, resulting in pulmonary embolism (PE), which can be life-threatening.
Orthopaedic patients are particularly susceptible to venous thromboembolism because surgery and trauma lead to endothelial injury, venous stasis, and hypercoagulability. Major procedures such as hip replacement, knee replacement, and pelvic or lower limb fractures significantly increase the risk of thromboembolic events.
Therefore prevention of DVT using pharmacological and mechanical methods forms an essential component of perioperative orthopaedic care.
The development of venous thrombosis is explained by Virchow triad, which describes three major factors that contribute to thrombus formation.
| Component | Explanation |
|---|---|
| Venous stasis | Reduced blood flow due to immobilization |
| Endothelial injury | Damage to vessel wall during trauma or surgery |
| Hypercoagulability | Increased clotting tendency |
Orthopaedic trauma and surgery frequently involve all three elements of Virchow triad, making patients particularly vulnerable to thrombus formation.
Multiple patient-related and procedure-related factors influence the risk of developing DVT.
Among orthopaedic procedures, hip and knee arthroplasty are associated with the highest incidence of venous thromboembolism.
Deep vein thrombosis may be asymptomatic in many patients. When symptoms occur, they are usually related to obstruction of venous outflow and local inflammation.
Severe cases may present with pulmonary embolism characterized by shortness of breath, chest pain, tachycardia, and hypoxia.
The diagnosis of DVT requires a combination of clinical evaluation and imaging studies.
Compression ultrasound is the most commonly used diagnostic tool because it is non-invasive and highly sensitive for detecting proximal venous thrombosis.
Mechanical methods aim to prevent venous stasis by improving venous return from the lower limbs.
These methods are particularly useful in patients who cannot receive pharmacological prophylaxis due to bleeding risk.
Anticoagulant medications are widely used to prevent thrombus formation after orthopaedic surgery.
| Drug | Mechanism |
|---|---|
| Low molecular weight heparin | Inhibits factor Xa |
| Unfractionated heparin | Enhances antithrombin activity |
| Direct oral anticoagulants | Factor Xa or thrombin inhibition |
| Warfarin | Vitamin K antagonist |
Low molecular weight heparin is the most commonly used pharmacological prophylaxis in orthopaedic surgery due to its predictable anticoagulant effect and ease of administration.
The duration of prophylaxis depends on the type of surgery performed.
| Procedure | Recommended Duration |
|---|---|
| Total hip replacement | 28–35 days |
| Total knee replacement | 10–14 days |
| Hip fracture surgery | 28–35 days |
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