Incidence of Venous Thromboembolism and Thromboprophylaxis after Total Hip or Knee Arthroplasty

Background Despite numerous guidelines and consensus statements on venous thromboembolism (VTE) prophylaxis, there appears to be a large gap between evidence and practice. Aim To identify the incidence of VTE, thromboprophylaxis practice, VTE risk factors, and bleeding complications in patients undergoing elective total hip or knee arthroplasty. Method Patients who underwent elective total hip or knee arthroplasty from 1 January 2004 to 31 December 2005 were identified retrospectively from medical records at two hospitals. A clinical case audit was performed and data collected on the 3‐month incidence of VTE, thromboprophylaxis practice, VTE risk factors and bleeding episodes. Results VTE incidence was 13% (in‐hospital incidence 9.3% and 3‐month readmission incidence 3.3%) and was significantly higher at Hospital 1 for unilateral total knee arthroplasty (p = 0.02) and unilateral total hip arthroplasty (p = 0.02). At both hospitals the 3‐month incidence of VTE was 16% post unilateral total knee arthroplasty compared to 7.7% post unilateral total hip arthroplasty (p = 0.06). 99% of patients received appropriate pharmacological prophylaxis and of these 87% received an appropriate dose. 17 patients (55%) that developed VTE had one or more risk factors. There were 23 cases (9.3%) of minor bleeding and 4 cases (1.6%) of major bleeding. Conclusion VTE incidence was higher than that quoted in the literature, which may reflect high usage of pre‐discharge deep vein thrombosis screening in the study population. There is a need to develop and disseminate management algorithms for elective total hip or knee arthroplasty in the local setting.