Management of Venous Thromboembolism After Hip and Knee Arthroplasty

Author(s): Alexander Postajian, Edgmin Rostomian, Alexander Abdou, Vedi Hatamian, Samson Keshishian, Devendra K. Agrawal

Venous thromboembolism (VTE), a term encompassing both deep vein thrombosis (DVT) and pulmonary embolism (PE), remains a leading cause of mortality following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Optimizing thromboprophylaxis, or the prevention of VTE after surgery, is becoming increasingly critical as the demand and frequency of total joint arthroplasty rises globally. This review covers the current literature on the risk factors, detection, and prevention of VTE in patients undergoing THA and TKA. It compares the efficacy and safety profiles of the most common pharmacological interventions including aspirin, low molecular weight heparin, rivaroxaban, apixaban, and warfarin. Mechanical methods, such as pneumatic compression devices, as well as intraoperative considerations, such as anesthesia modality, operative time, and tourniquet time, are also discussed. Furthermore, this review explores recent surgical advancements including minimally invasive approaches and robotic-assisted THA and TKA. Despite advancements and extensive research, the optimal thromboprophylaxis regimen remains debated, which highlights the need for individualized, patient-centered approaches to thromboprophylaxis.