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Is Pharmacological Thromboprophylaxis Truly Necessary: Predictive Factors for Venous Thromboembolic Events Post-Total Knee Arthroplasty in an Asian Population

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Journal of Clinical Orthopaedics | Vol 10 | Issue 1 | January-June 2025 | page: 14-20 | Zavier Yongxuan Lim, Lynn Thwin, Kelvin Guoping Tan

DOI: https://doi.org/10.13107/jcorth.2025.v10i01.704

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 21 Feb 2025, Review Date: 18 Mar 2025, Accepted Date: 26 April 2025 & Published Date: 30 Jun 2025

Author: Zavier Yongxuan Lim [1], Lynn Thwin [1], Kelvin Guoping Tan [1]

[1] Department of Orthopaedic Surgery, Tan Tock Seng Hospital (Singapore), 11 Jln Tan Tock Seng, Singapore 308433

Address of Correspondence

Dr. Zavier Yongxuan Lim,
Department of Orthopaedic Surgery, Tan Tock Seng Hospital (Singapore), 11 Jln Tan Tock Seng, Singapore 308433 6256 6011.
E-mail: yongxuan.lim@mohh.com.sg

Abstract

Introduction: Venous thromboembolic prophylaxis is routinely used in elective total knee arthroplasty (TKA) patients worldwide, and current guidelines vary from aspirin to low molecular weight heparin in combination with mechanical prophylaxis, and direct oral anticoagulants. This study aimed to identify predictive or protective factors for VTEs in an Asian hospital and examine the efficacy of pharmacological VTE prophylaxis.
Materials and Methods: A retrospective cohort study of 2,014 patients who underwent primary TKAs between 2017 and 2022 was performed. All patients received mechanical thromboprophylaxis postoperatively. Patients who were symptomatic were referred for radiological investigations to exclude VTE. We evaluated patient demographics, co-morbidities, and surgical parameters to establish the overall incidence of symptomatic VTEs and risk factors for VTEs.
Results: There were 23 (1.14%) incidences of symptomatic VTEs, of which 1 patient developed pulmonary embolism, and 22 deep vein thrombosis. The incidence of VTE was 0.69% (10/1449) for patients on mechanical prophylaxis only, 2.08% (9/432) for patients on aspirin, 3.67% (4/109) for patients on clexane, 0% (0/19) for patients on clopidogrel, and 0% (0/5) for patients on DOACs. Multivariate analysis revealed length of stay (P < 0.001), the need for blood transfusion (P = 0.007), choice of thromboprophylaxis (P = 0.049), and diagnosis (P = 0.048) were independent risk factors for VTE. The use of tranexamic acid did not significantly affect VTE rates in the model (P = 0.059).
Conclusion: Pharmacological thromboprophylaxis may not be required post-operative in the Asian population. The identification of risk factors in this study allows surgeons to individualise risk counselling for patients listed for elective TKAs and choose appropriate thromboprophylaxis methods.
Keywords: Knee arthroplasty, Arthroplasty, Replacement, Knee, Thromboprophylaxis, Venous thrombosis, Asians

References

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How to Cite this article: Lim ZY, Thwin L, Tan KG. Is Pharmacological Thromboprophylaxis Truly Necessary: Predictive Factors for Venous Thromboembolic Events Post-Total Knee Arthroplasty in an Asian Population. Journal of Clinical Orthopaedics. January-June 2025;10(1):14-20.

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Mucoid Degeneration of Anterior Cruciate Ligament – A Review of Literature

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Journal of Clinical Orthopaedics | Vol 9 | Issue 2 |  July-December 2024 | page: 38-43 | Sujit Korday , Pushkar Khandekar , Suhail Kantawala , Nicholas Antao

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.658

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted Date: 01 Nov 2024, Review Date: 10 Nov 2024, Accepted Date: 28 Nov 2024 & Published Date: 10 Dec 2024

Author: Sujit Korday  [1], Pushkar Khandekar [1], Suhail Kantawala [2], Nicholas Antao [2]

[1] Department of Orthopedics, V. N. Desai Hospital, Santacruz East, Mumbai, Maharashtra, India.
[2] Department of Orthopedics,Holy Spirit Hospital, Mahakali Caves Road, Andheri East, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Pushkar Khandekar,
Department of Orthopaedics, V. N. Desai Hospital, Santacruz East, Mumbai, Maharashtra, India.
E-mail: drpushkarkhandekar@gmail.com

Abstract

Mucoid degeneration of the anterior cruciate ligament (MD-ACL), once thought to be a rare entity, is seen not so uncommonly in present day orthopaedic practice. Several hypotheses attempt to explain this entity. Clinically, it presents as knee pain with limitation of flexion or extension. There is no specific test available to clinically diagnose MD-ACL. Magnetic Resonance Imaging (MRI) remains the imaging modality of choice to diagnose MD-ACL. Therefore, a high index of suspicion is necessary to be able to diagnose this condition. This article reviews the available literature about the etio-pathological aspects of MD-ACL, its clinical features, radiological and arthroscopic findings, as well as various treatment modalities available.
Keywords: Mucoid degeneration, anterior cruciate ligament, knee, arthroscopy, MRI.

References

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7. Khanna G, Sharma R, Bhardwaj A, Gurdutta HS, Agrawal DK, Rathore AS. Mucoid degeneration of the anterior cruciate ligament: Partial arthroscopic debridement and outcomes. Journal of Arthroscopy and Joint Surgery. 2016 Jan;3(1):28–33.
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How to Cite this article: Korday S, Khandekar P, Kantawala S, Antao N. Mucoid Degeneration of Anterior Cruciate Ligament – A Review of Literature. Journal of Clinical Orthopaedics July-December 2024;9(2):38-43.

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Habitual Dislocation of the Patella Managed by a Two-in-One Procedure

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Journal of Clinical Orthopaedics | Vol 9 | Issue 2 |  July-December 2024 | page: 63-66 | Ravi Mittal, M L V Sai Krishna

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.668

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted Date: 13 Jul 2024, Review Date: 18 Aug 2024, Accepted Date: 15 Sep 2024 & Published Date: 10 Dec 2024

Author: Ravi Mittal [1], M L V Sai Krishna [2]

[1] Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India,
[2] Department of Orthopaedics, Aayush Hospitals, Eluru, Andhra Pradesh, India

Address of Correspondence

M L V Sai Krishna,
Department of Orthopaedics, Aayush Hospitals, Eluru, Andhra Pradesh, India.
E-mail: krishna.mlv.sai@gmail.com

Abstract

Introduction: Habitual dislocation of the patella is a complex pathological condition of the patella which is characterized by lateral dislocation of the patella with flexion and relocation of the same with extension of the knee. There are numerous surgical procedures with various modifications that have been described in the literature based on the origin of pathology (soft tissue or bone). In this case series of 15 children, we described our technique of two-in-one procedure.
Materials and Methods: We included 15 patients with habitual dislocation of the patella between the ages of 5 and 9 years. In all the patients a detailed evaluation was done preoperatively and all of them were managed by a two-in-one procedure and followed up at 3 months and 1 year.
Results: There was no recurrence of dislocation in any of the patients and all the patients had attained their full range of movement by 1 year.
Conclusion: The two-in-one procedure is a simple and reproducible procedure for the treatment of habitual dislocation of the patella without any bony involvement. The procedure included graded lateral soft-tissue release and the Roux Goldthwait procedure. The amount of lateral soft-tissue release required is titrated intraoperatively.
Keywords: Habitual dislocation, Patella, Two in procedure, Knee.

References

1. Eilert RE. Congenital dislocation of the patella. Clin Orthop Relat Res 2001;389:22-9.
2. Bergmann NR, Williams PF. Habitual dislocation of the patella in flexion. J Bone Joint Surg Br 1988;70B:415-9.
3. Joo SY, Park KB, Kim BR, Park HW, Kim HW. The “four-in-one” procedure for habitual dislocation of the patella in children: Early results in patients with severe generalised ligamentous laxity and aplasis of the trochlear groove. J Bone Joint Sur Br 2007;89:1645-9.
4. Goldthwait JE. Slipping or recurrent dislocation of the patella: With the report of eleven cases. American Journal of Orthopedic Surgery, Vol. 1, pp. 293-308, 1903. J Bone Joint Surg 2003;85-A:2489.
5. Bakshi DP. Pes anserinus transposition for patellar dislocation. Long term follow up results. J Bone Joint Surg Br 1993;75B:305-10.
6. Gao GX, Lee EH, Bose K. Surgical management of congenital and habitual dislocation of the patellar. J Pediatr Orthop 1990;10:255-60.
7. Lai KA, Shen WJ, Lin CJ, Lin YT, Chen CY, Chang KC. Vastus lateralis fibrosis in habitual patella dislocation: An MRI study in 28 patients. Acta Orthop Scand 2000;71:394-8.
8. Niedzielski KR, Malecki K, Flont P, Fabis J. The results of an extensive soft-tissue procedure in the treatment of obligatory patellar dislocation in children with ligamentous laxity: A post-operative isokinetic study. Bone Joint J 2015;97-B:129-33.
9. Mittal R, Sitender, Jain S, Shukla A. Habitual patellar dislocation-management by two in one procedure, short term results. Indian J Orthop 2020;55:392-6.

How to Cite this article: Mittal R, Sai Krishna MLV. Habitual Dislocation of the Patella Managed by a Two-in-One Procedure. Journal of Clinical Orthopaedics 2024:July-December:9(2)63-66.

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Non Standard Deviation – Managing angular deformities around the knee in young age

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Journal of Clinical Orthopaedics | Vol 8 | Issue 1 |  Jan-Jun 2023 | page: 32-37 | Binoti Sheth

DOI: 10.13107/jcorth.2023.v08i01.559

Author: Binoti Sheth [1]

[1] Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India.

Address of Correspondence
Dr. Binoti Sheth, MS, DNB, FCPS, D. Orth.
Professor and Head of Unit, Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General
Hospital, Sion, Mumbai, India.
E-mail: binotisheth@yahoo.com

Abstract

Angular deformities around the knee in children are common presentations in day to day practice. While some of the deformities are physiological that need careful observation, the others are pathological and need timely medical or surgical intervention. Systematic evaluation of the deformity is the first step in making the correct decision about the management. The right choice of treatment, the correct timing and perfect execution of the technique are necessary for optimum outcome. This article describes the aetiology, clinicoradiological evaluation and management of angular deformities around the knee in children.

Keywords: Knee, Angular deformity, Children.

References

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  2. Valentino Coppa, Mario Marinelli: Coronal plane deformity around the knee in the skeletally immature population: A review of principles of evaluation and treatment World Journal of Orthopaedics 2022, May 13(5):427-443.
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How to Cite this article: Sheth B. Non Standard Deviation – Managing angular deformities around the knee in young agee. Journal of Clinical Orthopaedics Jan-Jun 2023;8(1):32-37.

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