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Study: Up to 10% of patients develop thromboembolic complications after total ankle replacement

Issue: August 2013

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HOLLYWOOD, Fla. — Thromboembolic complications and deep vein thrombosis rates in patients who have had total ankle replacements are comparable to those of patients who undergo hip and knee replacement, according to a study results presented at the American Orthopaedic Foot and Ankle Society Annual Meeting, here.

“The incidence of thromboembolic complications after total ankle replacement in the current literature is between 0 and almost 10%,” Alexej Barg, MD, said. “In our patient cohort, the incidence was almost 3.5%, which is comparable to data observed in patients undergoing joint replacement of the hip or knee joint.”

 

Alexej Barg

Barg and the researchers at Kantonsspital Liestal in Switzerland conducted a systematic review of the literature including Medline, ScienceDirect, Cochrane, EmbaseTM, CINAHL and SpringerLink and top orthopedic journals. They extracted information on 964 total ankle replacements performed between 2000 and 2009 at 28 different clinics. The majority of studies included were level IV evidence. He said there is limited literature on the incidence of thromboembolic prophylaxis after total ankle replacement (TAR).

The researchers found a range of 0% to 10% of patients had of thromboembolic complications after TAR and 3.5% of patients had symptomatic deep vein thrombosis (DVT) following TAR. Thirty-one patients had symptomatic DVT but there was no pulmonary embolism. Statistically significant independent risk factors for thromboembolic events were obesity, previous DVT and patients who were not full weight-bearing postoperatively. Nonsignificant risk factors included gender, tobacco use and prolonged surgery duration, according to Barg. Twenty studies described low-molecular weight heparin as the method of prophylaxis given to patients for 6 weeks postoperatively.

“We suggest prophylaxis using low molecular weight heparin in patients with known risk factors,” Barg said.

Reference:

Barg. Paper #SS-14. Presented at: American Orthopaedic Foot and Ankle Society Annual Meeting; July 18-20, 2013; Hollywood, Fla.

Disclosure: Barg has no relevant financial disclosures.