Arthroscopy: The Journal of Arthroscopic & Related Surgery
Current ConceptsVenous Thromboembolism in Lower Extremity Arthroscopy
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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Cited by (47)
Incidence of Venous Thromboembolism After Hip Arthroscopy Is Low With or Without Prophylaxis but Risk Factors Include Oral Contraceptive Use, Obesity, and Malignancy
2023, Arthroscopy - Journal of Arthroscopic and Related SurgeryUnexpectedly high incidence of venous thromboembolism after arthroscopic anterior cruciate ligament reconstruction: Prospective, observational study
2020, Journal of ISAKOSCitation Excerpt :Pharmacological prophylaxis, such as low-molecular-weight heparin (LMWH), is reported to be effective for reducing DVT after knee arthroscopy8 13 and ACLR.9 However, whether the benefits of LMWH outweigh the risks and costs remains controversial.14 According to the American College of Chest Physicians guidelines, pharmacological prophylaxis was not suggested for patients without histories of DVT and PE.15
Postoperative Management
2020, Evidence-Based Management of Complex Knee Injuries: Restoring the Anatomy to Achieve Best OutcomesMultiple Ligament Injury
2020, Complications in Orthopaedics: Sports MedicineBilateral pulmonary embolism after arthroscopic anterior cruciate ligament reconstruction: A case report
2018, International Journal of Surgery Case ReportsCitation Excerpt :The incidence of venous thromboembolism (VTE), which includes deep venous thrombosis (DVT) and pulmonary embolism (PE), is very low in healthy adults, but is still a significant complication which can cause serious morbidity and has the potential to be fatal. The majority of existing data regarding the incidence of VTE after arthroscopic surgeries of the lower extremity relate to the knee, with no reports of cases of VTE events associated with ankle or hip arthroscopy [2–5]. The risk of VTE is lower in arthroscopic ACL reconstruction than that in knee arthroplasties, where the incidence can reach 70% if no prophylaxis is given.
Thromboembolic Events After Arthroscopic Knee Surgery: Increased Risk at High Elevation
2016, Arthroscopy - Journal of Arthroscopic and Related Surgery
The authors report no conflict of interest.