Current Concepts
Venous Thromboembolism in Lower Extremity Arthroscopy

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Abstract

Venous thromboembolism (VTE) is a relatively rare complication of arthroscopic surgery of the lower extremity, but it does have the potential to result in significant morbidity and possible mortality. VTE has been reported to occur with knee arthroscopy, and guidelines for VTE prophylaxis before and after knee arthroscopy have been proposed. There are much fewer data regarding the incidence of VTE occurring after arthroscopy of the ankle and the hip. This article reviews the literature on the incidence, treatment, and prevention of VTE in association with arthroscopy of the lower extremity.

Section snippets

Hip Arthroscopy

In a review article regarding hip arthroscopy published 20 years ago, Hawkins9 warned that “systemic complications, such as pulmonary emboli, must always be considered.” In multiple series of hip arthroscopy cases published in the past 2 decades, however, PE or DVT has simply not been reported. No currently published study has specifically focused on this issue, but a review of more than 5,500 cases in the literature has revealed a 0% rate of DVT and PE (Table 1).10, 11, 12, 13, 14, 15, 16, 17,

Ankle Arthroscopy

As in hip arthroscopy, ankle arthroscopy has a low rate of VTE. While not specific for ankle arthroscopy, a 0.2% to 4% incidence of VTE has been reported in association with all types of foot and ankle surgery.37, 38, 39 A review of recent literature specific for ankle arthroscopy confirms that this very low incidence rate can indeed be extrapolated to arthroscopic ankle surgery. In 15 studies involving more than 1,300 patients total, no DVT or PE was reported (Table 3).40, 41, 42, 43, 44, 45,

Knee Arthroscopy

The majority of the literature regarding VTE of lower extremity arthroscopy involves the knee. The two major groups of studies that exist are those determining the incidence of VTE without prophylaxis and those evaluating the prophylactic benefit of low–molecular weight heparin (LMWH). The remaining literature involves case reports and small series illustrating important considerations in medical management. Upon a thorough review of the literature, the incidence of VTE associated with knee

Conclusions

VTE remains one of the most feared potential complications of arthroscopy of the lower extremity. There have been no reports of cases of DVT or PE associated with hip or ankle arthroscopy to date, and thus the surgeon should base prophylaxis decisions before these procedures on the existing medical factors associated with each individual patient. The vast majority of existing data about VTE prophylaxis in lower extremity arthroscopy pertains to the knee, including specific guidelines and

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    The authors report no conflict of interest.

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