MDNews - Greater Kansas

COVER FEATURE +++++++++++++++++++++++++++++++ + + +++++++++++++++++++++++++++++++ ORTHOPEDICS SPOTLIGHT +++ +++ Reducing Blood Clots After Joint Replacement Surgery THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS (AAOS) BOARD OF DIRECTORS HAS UPDATED CLINICAL PRACTICE GUIDELINES FOR REDUCING THE RISKS OF BLOOD CLOTS AFTER HIP AND KNEE REPLACEMENT SURGERY. successful procedures in terms of restor- ing function and signifi cantly decreasing pain. Despite their outstanding successes, there are still risks associated with these joint replacement surgeries. Of primary concern is venous thromboembolic disease, which encompasses both deep vein thrombosis (DVT) and, although rare, pulmonary embolism (PE). In many patients, neither DVT nor PE A causes symptoms, although some patients may experience swelling of the legs and pain due to DVT and possibly shortness of breath, light-headedness, or chest congestion or pain as a result of PE. Guidelines Outlined To develop the new guidelines, work- group participants analyzed a variety of preventive measures for safety and effectiveness, including mechanical compression devices designed to improve blood fl ow to the legs following surgery and drug therapy, which involved anti- coagulants and aspirin. While additional research is needed to continue developing best strategies to help prevent venous thromboembolic disease, the AAOS recommends these precautions: + Patients should stop taking antico- agulant medications, such as aspirin and clopidogrel, as these medications increase risk of blood loss during surgery. + Health care providers should discuss the appropriate timing of stopping any medication with patients. + Prior history of DVT or PE is an addi- tional risk factor for thromboembolic NNUAL LY, MORE THAN 800,000 Americans undergo hip and knee replacement surgery — two of the most disease, and patients should disclose such histories to their surgeons. + Although evidence suggests that regional anesthesia — such as epidural or spinal — does not affect the occur- rence of DVT or PE, it does limit blood loss. Patients may want to consider hav- ing surgery performed under regional rather than general anesthesia. Care After Hip or Knee Replacement The following recommendations were also made for care after hip or knee replacement: + Hip and knee replacement patients should not have routine postoperative screening for thromboembolic disease with duplex ultrasonography, as screen- ing with this test does not signifi cantly reduce the rate of symptomatic DVT or PE or the rate of fatal PE. Instead, patients should receive anticoagulant therapy (unless medical history or condition suggests otherwise) and/or mechanical compression devices after a hip or knee replacement surgery. Since insuffi cient evidence exists that recommends any particular preventive strategy or the duration of these treat- ments, duration and type of preventive treatment should be determined by physician and patient. + Patients should get up and walk as soon and as safely as possible after surgery. To review the full guidelines, which are titled, "Preventing Venous Thromboembolic Disease in Patients Undergoing Elective Hip and Knee Arthroplasty," visit the AAOS website at www.aaos.org. ■

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