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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

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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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Potpourri – Recent and Relevant Literature in Periprosthetic Fractures Around the Knee

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Journal of Clinical Orthopaedics | Vol 9 | Issue 1 |  January-June 2024 | page: 52-56 | Clevio Desouza, Nicholas Antao

Open Access License: CC BY-NC 4.0

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

DOI: https://doi.org/10.13107/jcorth.2024.v09i01.634

Author: Clevio Desouza [1, 2], Nicholas Antao [2]

[1] Centre for Bone and Joints, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India,
[2] Department of Orthopaedics, Holy Spirit Hospital, Andheri, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Clevio Joao Baptista Desouza,
Centre for Bone and Joints, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India.
E-mail: ceviod@gmail.com

Abstract

Knee replacement stands as an effective treatment for alleviating pain and restoring function in cases of degenerative joint conditions. The escalating prevalence of knee replacements reflects their acknowledged success. Despite being a relatively uncommon complication, periprosthetic fractures surrounding total knee arthroplasties present intricate challenges, demanding proficiency in both arthroplasty and trauma reconstructive techniques from treating surgeons. The confluence of increased life expectancy and elevated functional expectations among elderly individuals may contribute to a heightened occurrence of periprosthetic fractures. Among these fractures, supracondylar fractures of the femur emerge as the most prevalent. This comprehensive review delves into the classification and diverse treatment modalities available for addressing periprosthetic fractures around total knee arthroplasties.
Keywords: Total Knee Arthroplasty, Replacement, Femur, Periprosthetic fractures

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How to Cite this article: Desouza C, Antao N. Potpourri – Recent and Relevant Literature in Periprosthetic Fractures Around the Knee. Journal of Clinical Orthopaedics 2024;January-June:9(1):52-56.

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