Intraoperative technique reduces DVT risk after total hip arthroplasty

NEW YORK (Reuters Health) – Use of a bone-vacuum technique to remove fat and bone particles during total hip arthroplasty can reduce the incidence of postoperative deep-vein thrombosis (DVT), according to a report published in the January issue of The Journal of Bone and Joint Surgery.

The authors point out that while the risk of thrombogenesis is often thought to be greatest after, rather than during, total hip arthroplasty, recent reports suggest that just the opposite is true.

Dr. Rocco Paolo Pitto, from the University of Auckland in New Zealand, and colleagues hypothesized that intraoperative interventions designed to limit fat and bone embolism may reduce the postoperative DVT risk.

The researchers randomized 130 patients undergoing total hip arthroplasty with cement to have the femoral component inserted with or without the use of a bone vacuum technique.
The technique involved the application of suction to a drainage cannula in the femur during insertion of the stem of the prosthesis, to prevent an increase in intramedullary pressure.

Echocardiographic evaluation during component insertion revealed a cascade of small embolic particles in 59 patients treated without vacuum, but in only 10 patients treated with vacuum. In addition, the intensity and duration of these events was significantly reduced in vacuum-treated patients (p < 0.001).

Ultrasonography on postoperative day 4 revealed the presence of DVTs in 12 patients managed without the vacuum technique, but in only 2 patients managed with the technique (p = 0.009).

"To our knowledge, the present study is the first randomized clinical trial designed to investigate the relationship between intraoperative fat and bone-marrow embolism and thrombosis of the deep venous system," the investigators note. The current findings seem to confirm the hypothesis that a reduction in intraoperative embolic events lowers the risk of postoperative DVT.

There is controversy regarding the best means of postoperative DVT prophylaxis in total hip patients, the authors point out. Regardless of the postoperative method selected, the investigators believe that it should be combined with an intraoperative method, such as the bone-vacuum technique.

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