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The Incidence of Deep-Vein Thrombosis Following Shoulder Arthroplasty

Authors: Andrew A Willis

References: Presented at AAOS 2005

Abstract
This is the first study to prospectively document the prevalence of DVT (13.0%) following reconstructive shoulder arthroplasty (100-consecutive patients).

The prevalence of deep-vein thrombosis (DVT) following reconstructive shoulder arthroplasty (RSA) surgery is unknown. The purpose of this study is to document the prevalence of DVT in this patient population.

One-hundred consecutive shoulder arthroplasty procedures (Total-73, Hemi-27) in (44)-males and (56)-females were prospectively followed for twelve-weeks (Age-68, 17-88). Risk factors for venous thromboembolic (VTE) disease were assessed preoperatively. Patients on routine anticoagulation therapy were excluded. A four-limb surveillance color flow Doppler ultrasound was performed two-days (100-patients) and twelve-weeks (50-patients) post-surgery, and the presence and location of DVT was recorded. Post-operative symptomatic or fatal pulmonary emboli (PE) were also recorded. Factors associated with VTE complications were identified using statistical software.

The overall prevalence of DVT was 13.0%. There were (13)-DVT in (12)-patients (6-upper, 7-lower extremity). There were (6)-ipsilateral and (0)-contralateral upper-DVT [subclavian/axillary-(5), axillary/brachial-(1)]. There were (5)-ipsilateral and (2)-contralateral lower-DVT [distal-(5), proximal-(2)]. The prevalence of DVT on the second day post-surgery was 10.0%(10/100) and the incidence of DVT at twelve-weeks was 6.0%(3/50). The incidence of symptomatic PE was 3.0%(nonfatal-2, fatal-1). Risk factors associated with VTE disease were history of previous DVT, PE, malignancy, multiple major medical diseases, and prolonged operative time.

The prevalence of DVT following RSA surgery in this prospective study was not insignificant (13.0%); higher than the prevalence reported for the general population [0.05%](1) as well as for age matched controls(2). Our findings suggest that VTE disease, including symptomatic PE, can occur in this patient population and shoulder surgeons should be aware of potential VTE-complications both in the acute and subacute peri-operative periods. Further studies are needed to determine the role of routine DVT chemoprophylaxis following shoulder arthroplasty surgery.

References

1. Fowkes, F. J., Price, J. F., and Fowkes, F. G.: Incidence of diagnosed deep vein thrombosis in the general population: systematic review. Eur. J Vasc. Endovasc. Surg. 25:1-5, 2003.

2. Nordstrom, M., Lindblad, B., Bergqvist, D., and Kjellstrom, T.: A prospective study of the incidence of deep-vein thrombosis within a defined urban population. J Intern. Med. 232:155-160, 1992.

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