Oral contraceptive use cited as a risk factor of VTE after hip arthroscopy

In a study of 144 patients, two women were diagnosed with VTE following hip arthroscopy.

Issue: February 10, 2013

In a recently presented study, researchers reported a low risk of venous thromboembolism following hip arthroscopy and identified oral contraceptive use and family history as risk factors for the this complication.

“There is a low rate of venous thromboembolism [VTE] postoperatively from hip arthroscopy in our series, 1.4%,” Roy I. Davidovitch, MD, said during his presentation. “We did not detect asymptomatic venous thromboembolism, with 58% of the patients undergoing an ultrasound. The [deep vein thrombosis] DVTs that were detected were symptomatic. We think that oral contraceptives are likely the most common risk factor in this patient population.”

Retrospective study

To determine the rate of VTE and DVT after hip arthroscopy, Davidovitch and colleagues conducted a retrospective study of 144 patients. They excluded five patients from the study who were either younger than 18 years or received postoperative prophylaxis. Patients included in the review had an average age of 37 years and a mean body mass index (BMI) of 25. Sixty-one percent of the patients were women.

The researchers reviewed their routine use of bilateral venous duplex ultrasounds to monitor for DVT at 2 weeks postoperatively. Perioperative factors, such as weight-bearing status, traction time and type of anesthesia used, were recorded. Most of the patients underwent general anesthesia, with an average anesthesia time of 101 minutes. The average traction time was 58 minutes, Davidovitch said.

Contraceptives and family history

The risk of VTE after hip arthroscopy was 1.4%, Davidovitch said. The two patients who developed the condition included a 28-year-old woman with acute symptomatic DVT diagnosed 14 days postoperatively who used oral contraceptives and had a 31 BMI, and a 30-year-old woman who was diagnosed with a pulmonary embolism prior to the 2-week ultrasound.

Oral contraceptive use and family history of DVT were the most common risk factors for DVT, Davidovitch said. The researchers found no cases of asymptomatic VTE.

Limitations of the study included its retrospective nature, small patient cohort and that only 58% of patients had ultrasounds due to insurance issues, Davidovitch said.

“There is a low risk of a venous thromboembolism after hip arthroscopy, and patients should be counseled regarding this risk,” he said. “At this point, there is no role for a universal prophylaxis or routine duplex studies following hip arthroscopy. Based on our findings we now utilize prophylaxis only for the high-risk patients, such as those with a previous history of a DVT, and discourage oral contraceptive use in the acute perioperative period.” – by Renee Blisard Buddle

Reference:

Davidovitch RI. The incidence of venous thromboembolism (VTE) after hip arthroscopy. Presented at: Arthroscopy Association of North America Annual Meeting; May 16-19, 2012; Orlando, Fla.

For more information:

Roy I. Davidovitch, MD, can be reached at NYU Hospital for Joint Diseases, Orthopaedic Surgery, 301 E. 17th St., Suite 1402, New York, NY 10001; email: roy.davidovitch@nyumc.org.
Disclosure: Davidovitch is a paid consultant for Stryker and owns stock in Surgix Ltd.