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Incidence of Symptomatic and Asymptomatic Venous Thromboembolism After Elective Knee Arthroscopic Surgery: A Retrospective Study With Routinely Applied Venography

  • Ye Sun
    Affiliations
    Center for Diagnosis and Treatment of Joint Disease, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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  • Dongyang Chen
    Affiliations
    Center for Diagnosis and Treatment of Joint Disease, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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  • Zhihong Xu
    Affiliations
    Center for Diagnosis and Treatment of Joint Disease, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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  • Dongquan Shi
    Affiliations
    Center for Diagnosis and Treatment of Joint Disease, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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  • Jin Dai
    Affiliations
    Center for Diagnosis and Treatment of Joint Disease, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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  • Jianghui Qin
    Affiliations
    Center for Diagnosis and Treatment of Joint Disease, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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  • Qing Jiang
    Correspondence
    Address correspondence to Qing Jiang, M.D., The Affiliated Hospital of Nanjing University Medical School, The Center for Diagnosis and Treatment of Joint Disease, Drum Tower Hospital, 321 Zhongshan Rd, Nanjing 210008, China.
    Affiliations
    Center for Diagnosis and Treatment of Joint Disease, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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      Purpose

      The purpose of this study was to assess the incidence of total venous thromboembolism (VTE) after knee arthroscopy with routinely applied venography.

      Methods

      We reviewed 537 consecutive patients undergoing arthroscopic knee surgery from March 2012 to July 2013. The surgical procedure was categorized as simple anterior cruciate ligament reconstruction (ACLR), posterior cruciate ligament reconstruction (PCLR), or reconstruction of both cruciate ligaments. All patients having arthroscopy in our institution were routinely examined with venography on the third postoperative day. Clinical signs of DVT were checked and recorded before venography.

      Results

      Eighty (14.9%) of 537 patients were diagnosed with VTE by venography. Of the 80 detected cases of VTE, only 20 (3.7%) patients presented with clinical signs of DVT, indicating that there were 60 (11.2%) asymptomatic cases. No patient died or presented with a clinically suspected pulmonary embolism (PE). Sex, body mass index (BMI), operative time, and duration of tourniquet application were not significant risk factors for DVT. Patient age (P < .0001) is a strongly significant risk factor for deep venous thrombosis (DVT). Compared with patients who underwent simple arthroscopic procedures, complex procedures—the reconstruction of 1 (P < .005) or both knee cruciate ligaments (P < .0005)—led to a significantly higher postoperative incidence of DVT.

      Conclusions

      The total incidence of VTE diagnosed with venography after arthroscopic knee surgery was 14.9%, of which only 3.7% of cases were symptomatic, indicating 11.2% cases of silent VTE. Advanced age and complex arthroscopic surgery are strongly associated with VTE.

      Level of Evidence

      Level IV, prognostic case series.
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      References

        • Michot M.
        • Conen D.
        • Holtz D.
        • et al.
        Prevention of deep-vein thrombosis in ambulatory arthroscopic knee surgery: A randomized trial of prophylaxis with low-molecular weight heparin.
        Arthroscopy. 2002; 18: 257-263
        • Marlovits S.
        • Striessnig G.
        • Schuster R.
        • et al.
        Extended-duration thromboprophylaxis with enoxaparin after arthroscopic surgery of the anterior cruciate ligament: A prospective, randomized, placebo-controlled study.
        Arthroscopy. 2007; 23: 696-702
        • Stringer M.D.
        • Steadman C.A.
        • Hedges A.R.
        • Thomas E.M.
        • Morley T.R.
        • Kakkar V.V.
        Deep vein thrombosis after elective knee surgery. An incidence study in 312 patients.
        J Bone Joint Surg Br. 1989; 71: 492-497
        • Cullison T.R.
        • Muldoon M.P.
        • Gorman J.D.
        • Goff W.B.
        The incidence of deep venous thrombosis in anterior cruciate ligament reconstruction.
        Arthroscopy. 1996; 12: 657-659
        • Schippinger G.
        • Wirnsberger G.H.
        • Obernosterer A.
        • Babinski K.
        Thromboembolic complications after arthroscopic knee surgery. Incidence and risk factors in 101 patients.
        Acta Orthop Scand. 1998; 69: 144-146
        • Demers C.
        • Marcoux S.
        • Ginsberg J.S.
        • Laroche F.
        • Cloutier R.
        • Poulin J.
        Incidence of venographically proved deep vein thrombosis after knee arthroscopy.
        Arch Intern Med. 1998; 158: 47-50
        • Williams Jr., J.S.
        • Hulstyn M.J.
        • Fadale P.D.
        • et al.
        Incidence of deep vein thrombosis after arthroscopic knee surgery: A prospective study.
        Arthroscopy. 1995; 11: 701-705
        • Adala R.
        • Anand A.
        • Kodikal G.
        Deep vein thrombosis and thromboprophylaxis in arthroscopic anterior cruciate ligament reconstruction.
        Indian J Orthop. 2011; 45: 450-453
        • Mauck K.F.
        • Froehling D.A.
        • Daniels P.R.
        • et al.
        Incidence of venous thromboembolism after elective knee arthroscopic surgery: A historical cohort study.
        J Thromb Haemost. 2013; 11: 1279-1286
        • Jameson S.S.
        • Dowen D.
        • James P.
        • Serrano-Pedraza I.
        • Reed M.R.
        • Deehan D.J.
        The burden of arthroscopy of the knee: A contemporary analysis of data from the English NHS.
        J Bone Joint Surg Br. 2011; 93: 1327-1333
        • Jameson S.S.
        • Dowen D.
        • James P.
        • Serrano-Pedraza I.
        • Reed M.R.
        • Deehan D.
        Complications following anterior cruciate ligament reconstruction in the English NHS.
        Knee. 2012; 19: 14-19
        • Maletis G.B.
        • Inacio M.C.
        • Reynolds S.
        • Funahashi T.T.
        Incidence of symptomatic venous thromboembolism after elective knee arthroscopy.
        J Bone Joint Surg Am. 2012; 94: 714-720
        • Wille-Jorgensen P.
        • Jorgensen L.N.
        • Crawford M.
        Asymptomatic postoperative deep vein thrombosis and the development of postthrombotic syndrome. A systematic review and meta-analysis.
        Thromb Haemost. 2005; 93: 236-241
        • Ciuti G.
        • Grifoni E.
        • Pavellini A.
        • et al.
        Incidence and characteristics of asymptomatic distal deep vein thrombosis unexpectedly found at admission in an internal medicine setting.
        Thromb Res. 2012; 130: 591-595
        • Struijk-Mulder M.C.
        • Ettema H.B.
        • Verheyen C.C.
        • Buller H.R.
        Deep vein thrombosis after arthroscopic anterior cruciate ligament reconstruction: A prospective cohort study of 100 patients.
        Arthroscopy. 2013; 29: 1211-1216
        • Sverzellati N.
        • De Filippo M.
        • Quintavalla M.
        • et al.
        Interobserver reliability of the chest radiograph in pulmonary embolism.
        Clin Appl Thromb Hemost. 2014; 20: 147-151
        • Ye S.
        • Dongyang C.
        • Zhihong X.
        • et al.
        The incidence of deep venous thrombosis after arthroscopically assisted anterior cruciate ligament reconstruction.
        Arthroscopy. 2013; 29: 742-747
        • Hegyes M.S.
        • Richardson M.W.
        • Miller M.D.
        Knee dislocation. Complications of nonoperative and operative management.
        Clin Sports Med. 2000; 19: 519-543
        • Rogers F.B.
        Venous thromboembolism in trauma patients: A review.
        Surgery. 2001; 130: 1-12
        • Stannard J.P.
        • Singhania A.K.
        • Lopez-Ben R.R.
        • et al.
        Deep-vein thrombosis in high-energy skeletal trauma despite thromboprophylaxis.
        J Bone Joint Surg Br. 2005; 87: 965-968
        • Park M.S.
        • Owen B.A.
        • Ballinger B.A.
        • et al.
        Quantification of hypercoagulable state after blunt trauma: Microparticle and thrombin generation are increased relative to injury severity, while standard markers are not.
        Surgery. 2012; 151: 831-836
        • Chinese Orthopaedic Association
        Prevention of venous thromboembolism after major orthopaedic surgery.
        Orthop Surg. 2010; 2: 81-85

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